
Oass 



COPYRIGHT DEPOSIT 



A SOUVENIR 



WITH AN 



AUTOBIOGRAPHICAL SKETCH OF EARLY LIFE 



AND 



SELECTED MISCELLANEOUS ADDRESSES 
AND COMMUNICATIONS. 



BY 



SAMUEL CLAGETT BUSEY, M.D., LL.D., 

PRESIDENT OF THE MEDICAL SOCIETY OF THE DISTRICT OF COLUMBIA. 1877, 1894, 1895, 1896 



( )M 5 






CITY OF WASHINGTON.. D. C. 

1896. 



6* 






^ 



Entered according to the Act of Congress, in the year 1896, by 

SAMUEL CLAGETT BUSEY, 
in the office of the Librarian of Congress, at Washington, D. C. 



DORNAN, PRINTER, 
PHILADELPHIA. 



"DONATIO PERFICITUR POSSESSIONS ACCIPIENTIS.' 




/$*?&- 






CONTENTS 



PAGE 

A souvenir ........... 9 

An autobiographical sketch of early life 13 

Birth and genealogy, 14 ; mother and father, 16 ; Clagett 
family and genealogy, 17 ; Clagett White and family, 18 ; Uncle 
Will and Aunt Hannah, 19; Bethesda Church, 21; William 
Grindage and West Point, 23 ; fox-hunting, 24 ; Potomac River 
boatmen. 26 ; homestead, 27 ; Bowie Bun and Cabin John, 28 ; 
evening social assemblages, 29 ; tallow-dip candles, 30 ; poultry- 
raising, 31 ; early period of life, 33 ; pleasures and pastimes, 34 ; 
fishing excursions, 35; snake-hunting, 36; summer environ- Q, 
ments, 37 ; autumn season, 38 ; nut-gathering, 38 ; winter sea- 
son and evenings, 39 ; rabbit-catching, 40 ; Glen Echo, 41 ; Christ- 
mas festivities, 42 ; aurora borealis, 45 ; wood-pile, 45 ; stormy 
weather, 46 ; hog-killing, 47 ; smoke-house, 48 ; herring-catch- 
ing, 48; sheep -shearing, 49; country weavers, 50; disappoint- 
ments, 50 ; Buddy Gus, 51 ; hardening boys, 53 ; Alfred and Tom, 
53, 54; brother William, 54; country boys, 56, sickness, blood 
and blind boils, 57 ; school days, 59 ; Nathan Loughborough, 
60; lock-out, 61; orchard farm, 63, visits to Georgetown, 63; 
market days, 65 ; James Wallace and Ellen Snowden, 66 ; Fourth 
of July Sunday-school, 67 ; barbecue, 68 ; inauguration of Wil- 
liam Henry Harrison, 69 ; visit to Congress, 71 ; Bockville 
Academy, 72; O. C. Wight, 73; smoking, 74; visits to Spring- 
field, 76 ; little sister, 77 ; slave families, 78 ; death of wife, 80. 

Address before the Medical Association of the District of Columbia 
on a resolution to revise its code of ethics and regulations . . 83 

Gathering, packing, transportation, and sale of fresh vegetables and 
fruits ; their chemical constitution and nutritive value ; competent 
inspection and free markets for producers ..... 87 

Address in obstretics and diseases of women and children . . .120 
Utilizing power in head- last labor, 121 ; correction of face 
presentations, 122 ; the sericeps, 123; obstetrical extractors, 125 ; 
transfusion, 127 ; puerperal fever, 130 ; puerperal eclampsia, 139 ; 
menstruation, 146: uterine fibroids, 147. 



vi CONTEXTS. 

PAGE 

Address delivered at the twenty-eighth annual commencement of the 
Medical Department of the University of Georgetown . . . 148 

Eulogy on Dr. William Beverly Drinkard 159 

The Columbia Hospital and Lying-in Asylum, a government institu- 
tion ; its past and present management . . . . . .163 

Washington malaria and the catching of cold ..... 180 

Differential diagnosis, 181 ; generation of miasmata, 182; to- 
pography and sewerage, 184; water-level, 193; ground-air, 195; 
ventilation and draught, 200 ; density of population, 201 ; abate- 
ment of evils, 202; clinical pictures, 203; catching of cold, 204; 
its symptomatic phenomena, 207 ; the fons et origo of indefinite 
ailments, 214; effects of refrigeration, 216; alcoholism, 218; 
fever and ague, 219; contest of pleasure, 220. 
First annual address of the President, delivered before the Wash- 
ington Obstetrical and Gynecological Society, October, 1883 . . 221 
Craniotomy upon the living foetus is not justifiable, 221, 223; 
craniotomy an ancient operation, 224; mortality studied chrono- 
logically, 225; successful craniotomist influenced by ambition, 
225 ; multiple Cesarean sections, 226 ; operative substitutes for 
craniotomy, 227; induction of premature labor, 232; criminal 
abortion, 233 ; revival of Sigaultian operation, 233 ; Cesarean 
section and substitutes, 235 ; Porro operation, 237 ; Lungren, 
237; Prof. Eustache, 239; nature will do much, 2-10; right of 
election, 241 ; relative value of lives, 242 ; laws of moral respon- 
sibilities, 243 ; diagnosis, 244. 

Prseses et rector, degree of LL. D 245 

Address of welcome to the American Gynecological Society, delivered 

at Washington, September 22, 1885 247 

The hygiene of pregnancy, delivered by the President of the Wash- 
ington Obstetrical and Gynecological Society, October 2, 1885 . 249 
Changes consequent upon pregnancy, 250 ; changes in blood, 
251 ; changes in glandular system, 252 ; changes in secretory 
and excretory glands, 252 ; changes in mammary glands, 252 ; 
studies in the lymphatic system, 253 ; physiological leucocytosis, 
254 ; liver and kidney, 255 ; physiological albuminuria, 257 ; 
similar phenomena, 258 ; management of pregnancy, 259. 
Address of welcome delivered to the Congress of American Physi- 
cians and Surgeons, September 18, 1888 263 

First assemblage of Congress, 263 ; Index Catalogue and gov- 
ernment bureaus, 265 ; generosity of the government, 266 ; rela- 
tion of government to city, 267. 
Address of welcome to the American Gynecological Society, delivered 
at Washington, September 18, 1888 269 



CONTENTS. vii 

PAGE 

The wrong of craniotomy upon the living foetus .... 270 

Previous prediction, 271; issue plainly stated, 272; right or 
wrong of craniotomy, 273 ; not a crime, 273 ; frequency of 
operation, 275; conception, 275; mother's love of offspring, 
277; criminal abortion, 278; brutal epoch of craniotomy, 279; 
percentage of craniotomy, 281 ; McDowell and ovariotomy, 281 ; 
alternative procedures give better results, 285 ; Barnes's conclu- 
sions, 284; final comparison, 286; percentage of lives saved, 287 ; 
uncertainties of life, 288 ; right of selection, 288 ; craniotomy 
indirect killing of aggressor, 289 ; final statistics, 291. 
The Hospital for Contagious Diseases ...... 291 

Address of the President at the seventy-fifth anniversary of the 

Medical Society of the District of Columbia, February 16, 1894 . 295 
After-dinner speech at banquet, February 16, 1894 .... 301 

Address of welcome to the Association of Military Surgeons, delivered 

at Washington, May 1, 1894 . .304 

Early condition of city, 306 ; condition during the war, 307 ; 
progress since the war, 308 ; power of the profession, 309. 
The Medical Society of the District of Columbia in 1894, with some 
important recommendations. Annual address of the President, 

delivered December 19, 1894 310 

Progress of the Society, 311, 314; milk legislation, 314; 
amendments suggested, 315; membership by invitation, 317 ; 
organization of Medical Association, 318 ; revolt of citizens, 
319; health department, 320; study of morbid preparations, 
324; duty of young members, 325; erection of suitable building, 
326; succession in office of President, 327. 
Address of welcome to the Southern Surgical and Gynecological 
Society, delivered at Washington, November 12, 1895 . . . 329 
Government realty in District of Columbia, 332 ; Government 
Bureax of Science, 336 ; medical colleges and societies in District 
of Columbia, 334. 
Annual address of the President of the Medical Society of the Dis- 
trict of Columbia, delivered December 18, 1895 .... 335 
Continual progress of the Society, 336 ; milk legislation, 337 ; 
protest of committee to Senate amendment to milk bill, 338 ; 
report on zymotic diseases, 341 ; medical practice law, 342 ; 
protest of committee to commissioners' amendment, 346 ; Dr. 
Custis, letter of, 349 ; conclusion from previous history, 351 ; 
medical schools and societies in tne District of Columbia, 352 ; 
classification of medical practice laws in States, 353 ; Society 
Transactions, 357. 
Report of committee on bill relating to testimony of physicians in 
the courts in the District of Columbia 363 



viii CONTENTS. 



Eulogy on Dr. Joseph Meredith Toner, delivered by the President 
of the Medical Society of the District of Columbia, October 21, 

1896 .368 

The year 1896: an epoch in the history of the Medical Society of 
the District of Columbia ; annual address delivered by the Presi- 
dent, December 16, 1896 372 

Medical practice act, 373; medical college law, 375; medical 
testimony act, 376 ; sanitation legislation, 377 ; publication of 
Transactions, 379; epoch year, 381. 



A SOUVENIR 



In consequence of an unfortunate accident, which occurred 
on April 5, 1895, 1 am no longer able, because of physical dis- 
abilities, to pursue, except to a very limited extent, the active 
duties of my profession, and am, therefore, compelled to seek 
diversion and employment in my library, engaged in such 
literary pursuit as may, from time to time, give pleasure and 
relief from the monotony of such enforced retirement and 
seclusion from the activities and responsibilities to which a 
long and laborious life had become inured. 

During the waking hours of such a life of physical in- 
capacity, not wholly free from suffering, the mind naturally 
dwells upon the friendships and good wishes of those who 
have so often and so kindly, in some one of many ways, 
manifested the fulness of their sympathy and personal regard, 
that I have sought some satisfactory and appropriate method 
of giving expression to reciprocal esteem which such valued 
friends might hold as a memorial in remembrance of one 
who wishes to acknowledge the obligations of gratitude. 

How best to accomplish this purpose and not transgress 
the limits of good taste and punctilio has been a subject of 
deliberate consideration, but the final conclusion seems to 
have been reached rather by the process of ratiocination 
than by inductive reasoning. 

In fulfilment of this conclusion I have brought together 
in this volume, in the form of a souvenir, my miscellaneous 
addresses delivered at different times, and under very vary- 
ing circumstances, because they set forth more distinctly than 
any class of my publications the trend of thought that has 

(9) 



10 A SOUVENIR. 

animated and directed my professional life, believing that 
such a compact reproduction would fully exhibit such special 
characteristics of mind and thought as would epitomize my 
life -history and present the dominant traits of a long and 
active professional career. 

It may be true that this method of giving expression to 
my gratitude and regard for valued friendships will suggest 
the insinuation of egotism ; but if so, it is the egotism of that 
independence of thought that frees conviction and expression 
from the restraint of some custom " more honored in the 
breach than the observance." 

Those of my friends who will receive a copy of this 
Souvenir, and who may choose to read its pages, will not fail 
to observe that I have uniformly contended for the honor and 
dignity of the medical profession, which I have believed 
could be more effectively maintained by the dicta of a high 
esprit de corps than by the penal provisions of a code of 
ethics but rarely enforced; that the highest standard of 
medical education was demanded by every consideration of 
professional duty and obligation, and that the profession 
should assert its prerogatives of right and power, in that 
legislators and all others in authority should come to know 
that science must dominate public opinion in all matters 
pertaining to preventive and remedial medicine. Whilst I 
may not live to witness the full fruition of these aspirations, 
I have lived to see such advanced progress in medical edu- 
cation that I am not without the hope of their complete 
realization in the near future. I have not claimed origi- 
nality in these contentions, but have followed the teachings 
of many of the most distinguished and honored of the pro- 
fession. I hold, in common with many others, the belief 
that scientific medicine cannot attain the full measure of its 
beneficence until the profession in general has attained that 
standard of knowledge which only can qualify it for the 
performance of the responsible and beneficent duties and 
obligations of a life-saving profession. I maintain now, as 



A SOUVENIR, 11 

I have long ago announced, that a life lost through ignorance, 
inattention, or neglect, is something more than a mistake 
to be appeased by one's complaisant promise to himself that 
such wrong shall not again be committed. The responsibility 
of misguided judgment and misapplied resource does not 
cease with the conviction of right. Right or wrong cannot 
be submitted to the arbitrament of such judgment, nor dis- 
missed with the declaration of one's own opinion of right. 
The tribunal of justice is at the bar of eternity. 

I take this occasion to gratify a long-cherished wish to 
communicate to my colleagues and confreres the statement of 
my firm belief in the beneficence and omnipotence of Almighty 
God and the efficacy of prayer. My past experience assures 
me that sincere and prayerful submission to the will of God 
may displace doubt and fear with confidence and courage, and 
that in His wisdom such help may be granted as will vouch- 
safe results not believed to be otherwise attainable. 

In a recent publication entitled Personal Reminiscences 
and Recollections of Forty-six Years' Membership In the Medi- 
cal Society of the District of Columbia and Residence in this 
City, I have narrated many incidents and circumstances of 
my professional life and associations. Could I have antici- 
pated the favor with which that volume has been received, 
as well by the lay as the professional reader, I would have 
added many omitted details and incidents, which, as it seems 
to me now, might have enhanced its historical value and 
interest. In the one hundred and eighty letters of acknowl- 
edgment now in my possession — many of which are from 
members of the immediate families or near descendants of 
those to whom reference was made in the volume — there does 
not appear one unpleasant criticism ; on the contrary, the 
flattering commendations of those correspondents, and of 
others, verbally communicated, have been so general that I 
am greatly surprised, as expressed by one in high educational 
standing, at my "success as an author." Some have, however, 
criticised the omissions of a frontispiece and an autobiography 



12 A SOUVENIR. 

of my earlier life, which, in deference to the suggestions, I 
now supply in this Souvenir. The following autobiographical 
sketch will relate to my boyhood life previous to the com- 
mencement of the study of medicine. The subsequent events 
and incidents of my life have been sufficiently set forth in 
the volume of Reminiscences. 

I have noted on the title-page the successive years of my 
election to the presidency of the Medical Society of the 
District of Columbia. No other member has attained to 
this distinction since 1866, the date of its organization as a 
scientific society devoted exclusively to the promotion and 
dissemination of scientific medicine. I recur to this fact 
because I value the distinction more highly than any honor 
that has come to me during my professional career, and wish 
to emphasize the expression of my grateful appreciation that 
those who will come after me may realize the honor and 
dignity of such distinction. 



AN AUTOBIOGRAPHICAL SKETCH OF EARLY LIFE. 



I WAS born, July 23, 1828, on a farm in Montgomery 
County, Maryland, on which the dwelling-house was located, 
about one and a half miles east of Cabin John Bridge, and 
resided there, except during the school sessions of (1841-45) 
the Rockville Academy, until I commenced the study of 
medicine in the office of Dr. Hezekiah Magruder, in George- 
town, D. C, in May, 1845. My mother, in her last will 
and testament, bequeathed the homestead and farm to my 
elder half-brother, Joseph Gustavus White, but provided a 
home at the homestead for my brother William and myself 
until each of us should reach the age of twenty-one years. 
I relinquished my privilege, and was never, after her death, 
at the homestead except as a casual visitor. My mother 
died in June, 1844, aged fifty-six, my half-brother in 1870, 
aged forty-nine, and my brother William in 1881, aged 
forty-nine. Since the death of William I have been the 
only survivor of the immediate family. 

After my half-brother took possession of the homestead, 
in 1844, he named it "Stony Lonesome," because of its 
secluded location and peculiar rock formations. In the 
forest surrounding and near by the dwelling-house were 
several enormous boulders, rising from ten to fifteen feet in 
height, and apparently so seated upon the apex of sharply 
defined elevations that they might be easily toppled over 
and rolled down the side of the abrupt knoll. I have occa- 
sionally reached the apex of some of the boulders by swing- 
ing from the overhanging limb of a tree, and slided pre- 
cipitously down the rugged side to the surface of the hill, 

(13) 



14 A SOUVENIR. 

to the great detriment of my clothes, but the amusement was 
too rough for frequent repetition. 

John Busey, my father, was the son of John Busey, and 
was born on a farm not far distant from " Stony Lonesome/' 
but soon after reaching his majority took up his residence 
with his uncle, Samuel Busey, on the farm known then, as 
now, as Springfield, situated on the old river road from 
Georgetown to the Great Falls of the Potomac, about one 
mile east of the Dalecarlia reservoir. Springfield was pur- 
chased in 1835 by Peter D. Posey, whose eldest daughter I 
married, and is now held by me, under his will, in trust for 
her two surviving sisters. After his marriage my father 
resided at the homestead of my mother, and died there in 
June, 1832, of an acute intestinal affection. 

Until a few years ago I believed the Busey family, the 
first of whom settled in one of the tobacco-growing counties 
of Maryland, was of French descent, because I had fre- 
quently seen the name in French medical literature, but 
spelled with an accent over the letter 6. After some corre- 
spondence with a member of a family of the same name, 
residing at Urbana, Illinois, and frequent interviews with 
the Hon. Samuel T. Busey, a member of the Fifty-second 
Congress, and one of that family, I became convinced of my 
error and of the correctness of their investigations, which 
traced the lineage of the family to Scottish origin. In proof 
of the Scottish origin, which the Urbana family seems to 
have established by direct descent, though failing to name 
the county in which the first emigrant settled, they cite some 
family characteristics, which I recognize, but I cannot con- 
nect my own family either with the Urbana family or with 
any other family bearing the same name in any other part 
of the country. 

The records of the Land Office of Maryland show that, 
in 1754, the Lord Proprietary patented to Edward Busey 
a tract of land, designated "timber land," lying in Fred- 
erick County. The tradition is that Edward was a Scotch 



SKETCH OF EARLY LIFE. 15 

emigrant, who left sons named respectively Samuel, John, 
William, Charles, and Severn. After the War of the Revo- 
lution, in which he was a soldier, the family, or a part of it, 
moved to Virginia and settled in the vicinity of the town 
now known as Danville. In 1838 the survivors of the 
emigrants to Virginia moved to Tennessee and Kentucky, 
and their descendants have scattered over the country. 

The same records show that during the years from April, 
1775, to April, 1820, five different tracts of land lying in 
Allegheny County, Maryland, were patented to Paul Busey, 
Bucey, or Bucy, and in 1793 a tract was patented to Paul 
Busey, Jr. The connection between Edward and Paul 
cannot be traced. The Urbana family claim descent from 
Matthew Busey, Sr., who was born in 1742, settled in North 
Carolina, and accompanied Daniel Boone to Kentucky, 
finally settling in Shelby County of that State. He left a 
large family. In the families of Edward and Matthew 
Busey appear sons named Samuel and John, which names 
reappear quite frequently in succeeding generations. The 
circumstances of like spelling of the names and naming of 
sons, Samuel and John, connect Edward and Matthew as 
near of kin. Edward was a land-owner in 1754, and must 
have been some years the senior of Matthew ; but as tradition 
omits the name of Matthew from the family of Edward, 
the relationship could not have been as near as father and 
son. My grandfather was named John and his brother 
Samuel, my father John and myself Samuel. Samuel, the 
eldest son of Matthew, from whom the Urbana family claim 
descent, died in Putnam County, Indiana, and John, the 
third son of Matthew, died in Bourbon County, Kentucky. 
As my grandfather, his brother and son John (my father) 
died in Montgomery County, Maryland, it is very clear that 
I cannot claim descent through either of the sons of Matthew ; 
but it appears very probable that my grandfather and his 
brother may have been sons of Edward, the Scotch emigrant 
and Revolutionary soldier. They did not go with the other 



16 A SOUVENIR. 

members of the family to Virginia, but remained in Mary- 
land. In some instances the name has been improperly 
spelled Bussey, Bucey, or Bucy ; in fact, these discrepancies 
are to be found in the records of Paul Busey, but it seems 
to be clearly established that all of these branches, together 
with the numerous families spelling the name Busey, had a 
common origin, or are descendants of either Edward or 
Matthew. 

My father was a gentleman by birth, a farmer by occupa- 
tion, a politician by profession, a sportsman who kept packs 
of trained hounds and horses to follow the hunt, and a gen- 
erous entertainer. Of course, he lived and died poor. 

My recollections of his last illness and death seem to be 
perfectly distinct and clear. It is one of the events of my 
early life that has never been forgotten, but has been kept 
green in remembrance by very frequent recurrence to the 
circumstances that were indelibly impressed upon my memory. 
Early in June, 1832, after his return from Georgetown, he 
was taken suddenly ill. Dr. James Wallace, the neighbor- 
hood physician, was summoned and bled him. The next 
day Dr. Wootten, of Rockville, was called in consultation. 
They bled him again, and again the next day. His illness 
was brief, not exceeding a week. I recall many of the in- 
cidents of the funeral, the service by Dr. John Mines, the 
baptism of my brother and myself, the assemblage of people, 
the ride to Springfield, where he was buried, the long pro- 
cession, preceded by the pall-bearers on horseback with long 
black sashes hanging from their hats, and the ride back to 
home with my mother. All this appears so fresh and vivid 
it must be correct. 

My mother, Rachel Clagett, was born in 1788, at Weston, 
Prince George's County, Maryland, two miles distant from 
the village of Upper Marlborough. She was the only 
daughter and elder child of Thomas Clagett, the seventh in 
lineal descent from Captain Thomas Clagett, the emigrant, 
to whom a tract of land, designated then and known now as 



SKETCH OF EARL Y LIFE. \ 7 

"Weston," was patented in 1671 by " Charles, absolute lord 
and proprietary of the Provinces of Maryland and Avalon, 
Lord Baron of Baltimore," and which has descended by 
entailment through eight generations to the eldest son, each 
one of whom was named Thomas. The last of the eight 
successive holders of this estate transferred it by will to his 
son Thomas, and in 1890 it was purchased at public auction 
by Charles J. Bonaparte, of Baltimore. This sale naturally 
excites regret that a descendant of such an ancestry should 
have permitted such an estate to pass away from a family 
which had held it in unbroken descent for a period of two 
hundred and twenty years, and in the soil of which, a few 
rods away from the dwelling, lie the remains of eight gen- 
erations of Thomas Clagett. 

The direct lineal descent of the Weston family from 
Captain Thomas Clagett, the emigrant, can be established as 
well by records on file as by documents in the possession of 
the surviving members of the family. In fact, the burial 
of the successive generations of the oldest sons, named 
Thomas, at Weston, clearly establishes the direct lineal 
descent of the Weston family from Thomas Clagett, to whom 
Weston was granted in 1671, and by him conveyed in 1702 
to his son Thomas, with a " remainder intail " to the heirs 
of said Thomas. I refer exclusively to the direct line and 
lateral branches, which spell their name with one g and a 
double t. 

It is proper in this connection to state that the last who 
inherited the estate by entailment was married twice. His 
eldest son by his first marriage was named Thomas William, 
who left a son Thomas, now residing at Keokuk, Prince 
George County, Md., whose eldest son is also named Thomas. 
The Thomas Clagett to whom the estate was willed was the 
eldest son by his second marriage ; so that, by the law of 
primogeniture, Weston would have descended through 
Thomas William and the line of his eldest son. 

The lineal descent of Captain Thomas Clagett, the emi- 

2 



18 A SOUVENIR. 

grant, can be established with equal certainty. He was born 
about 1640, came to this country in 1670, and settled in 
Calvert County, Md. His father, Edward Clagett, married 
a daughter of Thomas Adams, Lord Mayor of London and 
cavalier during the reign of Charles L, 1625-49. He named 
his son, the emigrant Thomas, after his grandfather. Edward 
was the son of George Clagett, Mayor of Canterbury in 1609, 
1622-32. Richard, father of George, was born about 1530, 
and married a daughter of Sir Robert Gouder. Robert of 
Mailing, Kent, the father of Richard, was born about 1490. 
The succession is from Robert, through Richard, George, 
Edward, and Captain Thomas the emigrant. Robert Clagett, 
of Mailing, bore the arms of the family, described as fol- 
lows : " Ermine on a fesse, sable, three pheons, gold ; crest, 
an eagle head, erased ermine, ducally crowned, or between 
two wings, sable." 

A number of the descendants of Captain Thomas Clagett 
were actively engaged in the Revolutionary War as private 
soldiers and subordinate officers. 

My mother was married early in life to her first cousin, 
Clagett White, the only son of Joseph White, and came with 
him to reside with his parents on the farm, through which 
the Washington aqueduct passes for a mile and a half after 
it crosses Cabin John, and continued to reside there for some 
years, until that part of the house on "Stony Lonesome" 
was built, as shown on the right in the illustration. The 
ruins of the old house on the river farm were removed when 
excavating for the aqueduct, and now I can only locate it 
by the proximity of a spring. The White family grave- 
yard, not far from the dwelling, has been so completely 
obliterated that I cannot designate the spot where lie the 
remains of several generations of a family which ceased to 
exist with the death of my half-brother. 

After the removal of Clagett White and his family, con- 
sisting of his wife (afterward my mother) and surviving 
children, a son and daughter, and the death of his parents, 




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SKETCH OF EARL Y LIFE. \ 9 

the dwelling on the river farm was occupied by two old 
negroes, Uncle Will and Aunt Hannah. They were left 
there to take care of the dwelling and generally to guard 
the farm. Hannah had been the cook of the White family, 
and Will the body-servant of his master, Joseph White. 
The old retired servants employed and amused themselves 
as best suited their pleasure and inclinations. Hannah had 
her garden-patch for vegetables and herbs, cow, chickens, 
and pet cat and dog. During peach-season she prepared a 
conserve, which she called " peach-cloth," by spreading in a 
thin layer on a smooth hard board the mashed pulp of soft, 
juicy peaches and drying it in the sun. When sufficiently 
dry she cut it into long strips several inches wide, rolled the 
strips into rolls two or three inches thick, and packed them 
away for winter use. It was not a very toothsome delicacy, 
but served as a very good swap for anything I might carry 
to her from the family table, and she took great pleasure in 
stuffing into my coat pocket one or more rolls. Uncle Will 
was a rough carpenter and occupied himself, when it suited 
his amiable disposition, in making baskets and chair-seats 
of white-oak splints, door-mats of corn-shucks, axe-helves, 
hoe-handles, toy wagons and sleds, and foot-stools, which he 
sold or gave away as might be his pleasure. His baskets 
and mats were neatly made and found ready sale. I have 
seen and probably have slept upon bed-bottoms made by him 
of splints. 

I made frequent visits to the old people in their lonely 
home by the river, and listened with great pleasure to their 
tales of life long gone before, and especially to the stories 
of old Marsa Joe, who must have been a lively, if not a 
unique character. On one occasion he ordered them to lay 
him out for dead in the kitchen, and after he had been thus 
prepared, and stretched out at full length on the cooling- 
board, with a copper cent of that date on each eye to keep 
the lids closed, he ordered them to take the corpse into the 
dwelling-house. In doing so they struck his head against 



20 A SOUVENIR. 

the sharp edge of the chimney-jamb, whereupon he damned 
them for their cruel treatment of a dead man. After being 
safely carried to his room he ordered them to sit by his 
side until the funeral service began. There he slept until 
awakened in the full consciousness of his freak, but offered 
no explanation for his conduct. 

After the death of Uncle Will, Aunt Hannah was re- 
moved with all her belongings to a quarter at the home- 
stead, where she lived for some years in great comfort, 
beloved and venerated by the family of slaves, and respected 
by everybody who knew her. During her later years she 
occupied herself for the most part in knitting stockings for 
her slave companions. 

My mother was endowed with great force of character 
and energy, though always, during my boyhood life, in feeble 
health. She managed her farming operations and conducted 
her business matters, sold the products of the farm, and 
made all purchases in person, but kept employed a white 
head-man, who was known as the overseer, whose duties 
were limited to the execution of her orders. During the 
planting, growing, and harvesting seasons she inspected the 
farming operations on horseback at sufficiently short in- 
tervals to keep herself well informed in regard to the prog- 
ress of the work. On such occasions I rode behind her 
until I was old enough to be trusted alone on horseback. 

She was frugal in her habits, lived in the ordinary com- 
fort and abundance of a prosperous farmer in those econom- 
ical times, was retiring and exclusive in social life, generous 
to a fault, and charitable to the neighborhood sick and 
needy. Her charity did not wait solicitation, but sought 
the opportunity to offer and give whatever would contribute 
to the comfort and supply the necessities of those w T ho would 
accept her donations and free-will offerings. Her larder 
was always open to the neighborhood poor and sick, and to 
some others who choose to tax her generosity by a system of 
borrowing. 



SKETCH OF EARLY LIFE. 21 

She was a consistent but somewhat austere communicant 
of the Presbyterian denomination, and attended service on 
alternate Sundays at Bethesda, some miles distant on the 
Rockville turnpike, and on intervening Sundays attended 
the Concord Methodist Church, a half-mile distant from the 
dwelling. Sunday was a day of rest and religious observ- 
ance. I was not allowed to go fishing, to bathe in the 
streams, to visit, play marbles, go barefooted, ride stick- 
horses, or even set my rabbit-traps. I kept on hand a large 
and well-selected stud of sleek prancing and racing steeds, 
and enjoyed the sport of fretting myself in speeding and 
jumping the nimble animals with amazing delight; nor 
could I understand why setting my rabbit-traps late Sunday 
afternoon and catching the hare early Monday morning was 
any more of a sin than setting them on Saturday afternoon 
and leaving the animals in the trap until Monday morning, 
but I obeyed the edict, made a "joy of duty," and went to 
Sunday-school and church service unless the elements were 
in such tempest that a country boy could not get outside of 
the front door, and, after returning home, whiled away the 
afternoon in such harmless dull pastimes as would not offend 
the keenest conception of innocent amusement. I did not ' 
have the resources of a schoolboy, for I had not then tasted 
of the wonderful and ingenious devices of pleasure which 
add so much charm to country schoolboy companionship, 
and make the life of those early years so impressive and 
attractive that one, even in old age, feels like wishing to live 
them over again. The most of such afternoons were passed, 
during proper seasons, in strutting about the lawn, clothed 
and booted in Sunday-go-to-meeting attire, sniffing the air, 
chasing beetles, and plucking butterflies ; and when confined 
to the house, lounging from chair to chair or romping and 
loafing from room to room in impatient and aimless search 
for something different or not to do. I must, however, add 
that during the later years of my mother's lifetime, when at 
home, Bible and Scriptural reading was a pleasant part of 



22 A SOUVENIR. 

my Sunday observances, and became sufficiently attractive 
to suggest the belief that I would eventually enter the min- 
istry, but nothing in those days could divert my love for the 
farm and country life, which seemed replete with the joys 
and pleasures which bring contentment and happiness. 

The old one-story stone church, with a high pulpit opposite 
the only entrance door, was destroyed by fire many years ago. 
A more commodious building was erected soon after the fire, 
near where the old church stood, in which the congregation 
has continued to worship, but few of those who attended 
Sunday-school with me are now living. During service the 
men and women sat on opposite sides of the church. Chil- 
dren occupied the pews with their mothers. As a rule, the 
men did not enter the church until the service began, but 
remained outside about the doorway, engaged in conversation 
concerning crops and farming prospects in general. Since I 
left the Sunday-school class, September, 1841, the neighbor- 
hood and vicinity of the old church have so greatly changed 
that but few of the landmarks remain to revive the memo- 
ries of that long-past period. 

My mother lived to see my half-brother complete his edu- 
cation at Benjamin Hallowell's academy in Alexandria, Va., 
where so many young men had been thoroughly equipped 
for intellectual occupations, take possession of his very large 
landed and personal estate, and prosecute his chosen occupa- 
tion of farming with such energy and so much success as to 
make him her exemplar of the mature life of her two minor 
sons. But her profound and unremitting concern for our 
future welfare never abated one "jot or tittle," and during 
the last hours of life she gave expression, in the hopeful 
words of a Christian mother, to her love and good wishes 
for our welfare, prosperity, and happiness, and with her last 
words, audibly but feebly spoken, she placed in the right 
hand of each of us a gold coin, the minted seal of her en- 
during love. During the past fifty-two years the recollection 
of that scene has so often come back to me more vividly 



SKETCH OF EARLY LIFE. 23 

with each successive impression upon the memory, until now 
I see the dream-picture of her last hours redolent with all 
the saintly qualities of a Christian woman and loving mother, 
who wished to live that she might continue to foster and 
watch over the lives of her minor sons. 

She was careful to inculcate the highest qualities of good 
morals, probity, and frugality, but was, perhaps, more espe- 
cially concerned in regard to our education. She knew the 
very moderate income which we would inherit would be 
insufficient to defray the necessary expenses of such educa- 
tion as she desired us to obtain, and never failed to impress 
upon us the importance of diligence in the acquisition of 
learning. 

During the last year of her life I was offered, through the 
influence of William Grindage, of Georgetown, a life-long 
and devoted friend of my father, the prospective appoint- 
ment to West Point ; but my mother refused her consent, 
and persistently designated the profession of medicine for 
me, which I as stubbornly declined, until I came to know, 
after her death, that she had done as she had often said she 
would do, given her entire realty to my half-brother, on the 
condition that he would pay to my brother, William, at his 
majority, a stipulated sum of money, giving as the reason 
for such bequest that it would be unwise to give either of 
the minor sons any part of her landed estate, because it was 
entirely surrounded by the lands of our half-brother. My 
half-brother's fortune was wasted through inattention to 
business and security obligations, and he died so poor that 
his estate was consumed in the payment of such debts. 

My mother left a small estate, which she so distributed as 
to equalize the incomes of my brother and myself, giving to 
me the less part, because I had inherited, by the will of 
my great-uncle, Samuel Busey, one-third of his estate, but 
which, with the addition derived from my mother's estate, 
yielded an inadequate income for my support and education 
even in those days of frugality and rigid economy. So that 



24 A SOUVENIR. 

long before I obtained my degree in medicine the principal 
had been greatly diminished. My mother made William 
Grindage my testamentary guardian, which he declined. 
According to the law in Maryland at that time, I was old 
enough to select his successor, and was summoned before the 
Orphans' Court to announce formally and solemnly my 
selection. I named my half-brother, but, in fact, from that 
date I managed my small estate as best I could, with the 
advice and occasional assistance of my best friend, William 
Grindage. He made to me all necessary advances of money 
when my income fell short, and never, during his lifetime, 
allowed me to want for anything necessary for my actual 
personal comfort or educational expenses, and, even after I 
was married, I knew where to apply for temporary help to 
make good small shortages of money. When, in 1849, I 
bought the lot on which I proceeded to erect a small dwell- 
ing-house, I borrowed from him every dollar of the purchase- 
money upon my personal note, payable at my convenience. 
He was a bachelor and lived to old age. I do not know 
that any relative or connection of his is now living, never- 
theless I make this record of my grateful appreciation of 
his kindness and in memory of his exemplary character and 
goodness of heart. 

In a previous paragraph (p. 16) I have referred to my 
father's love of the chase, to which he devoted annually the 
most of his life, between the times of fall wheat-seeding and 
spring corn-planting, with an occasional diversion at the 
race-course, which my indistinct memory locates in the 
suburbs of this city, in the immediate neighborhood of the 
thriving village of Mount Pleasant. I recur to these facts 
and circumstances because of the interesting recollections 
of the lives of the lovers of the chase in those days, as told 
to me by my mother. I was not quite five years old when 
my father died, and have no personal knowledge of the 
sport beyond the brief but familiar acquaintance with old 
u Vanity," the famous leader of the hounds, and the two 



SKETCH OF EARLY LIFE. 25 

hunters. " Jolly/' the favorite, was an ugly bob-tailed, 
mottle-colored beast, which spiked his ears at blow of horn, 
and followed the hunt with ferocious speed; and "Gin," the 
occasional substitute, to whose easy and steady gallop I be- 
came accustomed during the later years of her retirement 
from the sportsman's saddle. Notwithstanding my mother's 
antipathy to fox-hunting, she provided very carefully for the 
keep of these animals, which lived to a good old age and 
died natural deaths. 

The story, as told by her, is as follows : There was a 
coterie, it might be called a club nowadays, of an indefinite 
half-dozen gentlemen of reputed inherited wealth, residing 
within the limits of a sparsely populated country neighbor- 
hood, on farms descended to them through a line of colonial 
ancestry, and dwelling in mansion-houses mostly built of 
stone or brick. They assembled daily on weekdays, for the 
start, at the house of some one of them, at early breakfast, 
and again at the house of another, after the finish, at late 
dinner. They came with out-riders, slave body-servants, 
and the hounds of their respective kennels. The meals were 
very heavy and sumptuous, consisting of the best cuts of 
beef, or a whole mutton butchered for the occasion, and such 
other products as the farm might afford, with apple-jack and 
peach-brandy, the only domestic distillery products of that 
vicinity in those days. The preparation of these feasts and 
the clearing away of the debris after the departure of the 
gentlemen, with their out-riders, horses, and dogs, all of 
which had to be entertained in the conventional style of that 
coterie of elite sportsmen, imposed upon the good housewife 
and her retinue of slave servants constant and hard work, 
for two days of each week, from dawn of day till late candle- 
light. The wear, tire, and tear of such work was so great, 
with all the fun on one side, that it seems strange to me that 
a neighborhood custom should have trespassed so far beyond 
a humane consideration for the good and indulgent house- 
wives. My mother, having had previously a somewhat 



26 A SOUVENIR. 

similar, though not quite such an objectionable, experience 
during her early life at Weston, was determined, so far as 
she was concerned, to break up the weekly entertainments 
of meu, horses, and dogs before the inevitable results of 
ruined health and fortune should reduce her to poverty and 
bear her to an untimely grave. With marked emphasis in 
her words she has more than once told me how speedily and 
easily she accomplished her well-matured determination. 
Consequently my earliest recollections of the chase are lim- 
ited only to some knowledge of the survivors of my father's 
complete equipment for the hunt. 

Fox-hunting was, in those days as it is now, a gentleman's 
amusement, if chasing an innocent animal to his lair or to 
death by a kennel of bawling and devouring dogs that the 
first at the finish might, followed by the yelping hounds, 
bear the brush in triumph back to a sumptuous, if not a 
riotous, feast, is a rational enjoyment for cultivated gentle- 
men. Personally, I prefer the track of the anise-bag over a 
selected course rather than the trail of the wily fox, whose 
astute instinct leads him to his den by the most circuitous 
and inaccessible route, oftentimes deep in the wisely chosen 
and impregnable crevices of rocky formations. The simple 
but graphic story of my father's devotion to the sport that 
owes its pleasures to the pain of the dumb animals excited 
in me a lively and lasting prejudice against gaming the 
animal for the trophies of death and tail tufts. 

As a matter of interesting history not probably known to 
many now living, I feel at liberty to introduce a brief account 
of the terrible suffering of the Potomac River boatmen, of 
which I have often heard my mother speak. Previous to 
the construction of the Chesapeake and Ohio Canal George- 
town, and probably the cities of Washington and Alexandria, 
received the greater part of their supplies of flour from the 
mills on the upper Potomac, which were boated down the 
river in a rude sort of float boats, carrying from eighty to 
one hundred barrels each. The river is not navigable above 



SKETCH OF EARLY LIFE. 27 

the Little Falls, which has a fall of thirty-seven feet. At 
the Great Falls the fall is seventy-six feet and nine inches. 
Between these falls the river in many places is very rapid 
and shallow, and at many other points its course is so crowded 
with rocks and narrowed by islands that a boat cannot pass 
and escape total destruction. In 1784 the Legislature of 
Maryland chartered the Potomac Canal Company, which 
constructed at considerable cost canals with locks around 
these falls, widened and deepened the smaller channels around 
the islands, which were free from rocks, and in many other 
places, where practicable, dug canals across sharp curves and 
around the rocky and shallow rapids. In such manner an 
uncertain and dangerous water-way was crudely prepared for 
navigation with flat-bottomed scows, handled exclusively by 
hand power, with oars and push poles. One of the worst of 
the many disastrous parts of the river was near the dwelling 
of the White family, where my mother resided during the 
earlier period of her married life. There the wrecked and 
starving boatmen sought refuge from want and suffering, and 
had to be cared for, nursed, and fed until sufficiently recovered 
to seek on foot their homes. Boats and cargoes were fre- 
quently lost, and many of the boatmen were seriously injured. 
The homestead was situated about one and a half miles 
from the Potomac River, on rising ground, near the conflu- 
ence of Cabin John and Bowie Run, surrounded by an open 
lawn edged with forests on the sloping hill-sides, with a 
kitchen garden and orchard in front. Cabin John is a 
romantic and circuitous stream, with rocky shores, rushing 
gorges, dashing currents, and here and there a smooth but 
deep basin offering dangerous allurements to the youthful 
angler and swimmer. The affluent branch courses through 
meadow lands where snakes abound and the meadow-larks 
and bob-o-links hide their nests and young from intrusion. 
Along its way it receives the spring streams flowing through 
the fields and down the ravines of its picturesque watershed 
of rolling and forest lands, dotted, in my early life, here and 



28 A SOUVENIR. 

there with farm-houses primitive in style and with rude 
accommodations, heated only by great fireplaces with brass- 
mounted handirons of various design, and illuminated from 
late twilight until early bedtime with home-made tallow- 
dipped candles, and in due seasons with great blazing wood- 
fires. ' Whale-oil lamps and spermaceti candles were reserved 
for evenings when the country folks would come to tea and 
chat about crops, poultry prospects, courtships, births, roads, 
weather, church-going, fashion, and society and neighborhood 
doings in general. 

How these two streams derived their names I do not 
know, nor have I ever heard any authoritative statement in 
regard to the origin of the names. It was stated as a tradi- 
tion by some of the old persons that Bowie Run had been 
named after an original settler, but no one could locate his 
residence. It is a short stream, not by its course, over seven 
miles in length, but drains a very considerable watershed 
and fills to overflowing very rapidly during heavy rains. 
The legend of Cabin John was more definite, but none the 
less a fiction. The old negroes and some of the oldest white 
inhabitants took special pleasure in telling the story of the 
recluse, Captain John, who, at some remotely early period, 
had wandered from afar through the primeval forest until he 
reached its bank opposite the horseshoe bead not far below 
its confluence with Bowie Run, and there stopped to rest in 
the profound solitude of that secluded nook, undisturbed 
save by the chirping birds, " the chit-chat of an idle squirrel," 
and sound of the splashing water. Here he built a rude log 
cabin, and dwelt in lonesome retirement from the world. 
Some of the more superstitious negroes were wont to tell of 
visions of the grimly visaged ghost of Captain John as he 
walked in silence, with axe in hand, up and down the wood- 
land bank of the rugged stream, and sometimes when I have 
stood upon the opposite rocky promontory in the sharp curve 
of the fast running water, I have felt such a momentary 
thrill of horror at the fleeting thought that the ghost of a 



SKETCH OF EARLY LIFE. 29 

fiction might show his ghastly form and sharpened axe that 
I have chased away at a rapid speed from the haunted spot 
without looking back over my left shoulder to see if the 
apparition was in pursuit. 

The evening social assemblages of neighbors were occasions 
of special enjoyment to me. The visitors came informally 
and early, not by invitation but by notification that certain 
persons would come to tea on a day named, always given in 
time to enable the cook to be in readiness for a full supply 
of Maryland biscuits, with such additional good foods as 
would complete the menu of an abundant and sumptuous 
country supper, suited in variety and quantity to the taste of 
the fastidious and hungry. The early coming was a neces- 
sary prelude to the full enjoyment of the meal. It afforded 
the opportunity to exchange the gossipy chit-chat of the 
neighborhood, and to simmer down the newsy tittle-tattle to 
such topics of general conversation as would engage the 
attention of everybody when assembled around the table, 
where everyone talked at the same time and laughed out loud 
or smiled in silent response to the pervading conviviality. 
A country farm-house supper of biscuit, tea, and toothsome 
relishes seemed to inspire a well-chosen company with such 
good cheer and bonhomie as would make every face gleam 
and sparkle with delight, obliterate the wrinkles, furrows, 
and care of advancing life, and add to the freshness of youth 
the glow and radiance of beaming festivity. 

Some of the company were talkers from the start to the 
finish, with the last word added ; and others were loud and 
jolly laughers, all the more so when the repartee came quickly 
in a sally of folk-lore that would capture general attention and 
stampede the garrulous bumpkin who sought to monopolize 
the conversation with the pointless details of stale neighbor- 
hood gossip, and did not possess the suavity and ready wit 
to conceal the discomfiture of a laugh on the wrong side of 
the face. 

On such occasions I was duly instructed in the proprieties 



30 A SOUVENIR. 

of good behavior and taught the lesson of how to be seen 
and not heard, but I was not forbidden the privilege of being 
honey-fugled by some toothless spinster who claimed the 
right of sealing her good-will and friendly slaver with a 
righteous kiss. 

At supper I was seated at a side table and waited until I 
was served with that which somebody thought was best for 
me, without the privilege of picking and choosing. I was 
always hungry, but was soon so comfortably satisfied with 
the good eatings that I could listen in contentment to the 
dialogue of the merry company, and join in the laughter, 
provided I was not too boisterous. Of course, sometimes, 
boylike, I had to laugh all around both hands pressed firmly 
over my gaping mouth, and laugh until choked, and then the 
maid would thump me in the back until I breathed easy, and 
I was lucky if not sent " in durance vile " to weep and sleep. 

The " tallow-dip " candle was a primitive domestic manu- 
facture, and in many farm-houses supplied all the artificial 
illumination other than the blaze of the open wood-fires. 
The method of preparation is probably unknown to the 
present generation, except perhaps in certain limited regions 
of the country as yet inaccessible by the ordinary means of 
transportation. The tallow was prepared by rendering beef- 
fat and was preserved in moulds or cakes until candle- mak- 
ing time, usually during the winter months, came around in 
the successive routine of the housewife's domestic duties. 
Every frugal housekeeper kept on hand, carefully and prop- 
erly prepared, a number of round, smooth candle-dipping 
sticks, about two feet long by one-half to three-fourths of 
an inch in diameter. Around these sticks the wick, cut in 
fixed lengths, was folded, six or eight on each stick, and 
twisted so that from the loop surrounding the stick the 
double wick would hang in one straight line. When thus 
prepared in number to supply all the candles for the current 
candle-year, the sticks were hung in a frame so made that 
the ends would rest upon two parallel bars with the twisted 



SKETCH OF EARLY LIFE. 31 

wicks hanging downward. Tsvo or more large iron pots or 
other metal vessels were conveniently placed near this frame- 
work and partially filled with hot water, upon which was 
poured the hot melted tallow, filling the vessels brimful. The 
preparations being thus completed the operators took each 
stick in regular order and dipped the wick into the hot 
tallow, with a gentle swaying motion, so that each wick 
might be thoroughly saturated with the tallow, and when 
withdrawn each wick was drawn out straight by pulling 
from the end, before the stick was replaced in the frame to 
allow the adherent tallow to harden. This process of dip- 
ping was repeated at sufficient intervals until the candles 
had grown by the adhesion and congelation of the layers of 
tallow to the proper size, and, after hanging in the frame 
until thoroughly hardened, were stripped from the sticks and 
stored away for use. As thus made the candles were some- 
what irregular in form, without smooth surfaces, but the 
tallow was a homogeneous mass and sufficiently firm to retain 
shape for a long time. The tallow-dip is not a brilliant 
luminant, but in those early days two or more on the centre- 
table seemed to furnish all the light needed by those accus- 
tomed to their use. They needed careful and frequent 
snuffing to prevent the charred wicks from falling over 
and dimming the light. I have now in my possession two 
silver-plated candlesticks, one hundred and more years old, 
in which the tallow-dips were set when lighted, by which I 
have read the stories of Mother Goose, and studied weather 
prognostics in the Hagerstown Almanac, which was found 
in every farm-house in Maryland, in company with the Book 
of Martyrs and the Holy Bible. 

Poultry-raising was one of the economical industries of 
good housewifery, and was made profitable by the sale of 
the surplus product. Fricasseed and fried chicken, baked 
goose and duck, and roasted turkey were popular foods, and 
as necessary as convenient to supply the requirements of the 
farmer's table. Poultry-raising was not in those days a high 



32 A SOUVENIR. 

art, requiring elaborate and expensive preparations, with the 
appurtenances of glazed henneries, incubators, ornamental 
enclosures, and scientific feeding. In-and-in, and cross- 
breeding with new and fancy kinds did not command much 
attention. Fowl pedigrees followed the survival of the fit- 
test, selected according to taste, perhaps most often deter- 
mined by the color or richness of the plumage. This was 
certainly the custom in making the choice of the cocks, 
drakes, ganders, and turkey -gobblers. 

The ordinary preparations consisted of a rudely built 
board hen-house, a thatched roofed duckery, a turkey-roost, 
reached by climbing ; a goose shelter, feed pens, and coops 
for the protection of the different broods of the young. 
With the coming of springtime all these structures were 
renovated, cleansed, and put in perfect order, and then fol- 
lowed the making of nests and setting the eggs. With the 
beginning of the hatching began the momentous cares, disap- 
pointments, and anxiety of poultry-raising. The prepara- 
tion of foods for the broods and the feeding required special 
attention. Protection from cold and inclement weather was 
equally important. Separate houses or coops and feeding 
pens were provided for the broods of the different kinds. 
The brooding hen would pluck the turkey-poults and the 
gander would nip the chickabidies and ducklings. Brooding 
fowls are not friendly to the broods of other kinds, and some- 
times not to those of their own kind of different age from 
their own broods. These circumstances added ceaseless care 
and vigilance to the duties of the successful poultry-raiser. 

As a small boy I played the role of a looker-on, always 
keenly alive with loving admiration for the younglings, 
sometimes joining in the shooing to protect them from in- 
imical intruders, and occasionally getting a sharp nip and 
savage flap from an angry gander. An old gander is a 
plucky fowl and a fierce fighter. He does not like anybody, 
but has a special dislike for the small boy. When the goose 
is setting he struts around or sits near by, hisses at everyone 



SKETCH OF EARLY LIFE. 33 

who may approach the nest, and when the goslings are about 
his ferocity reaches such explosive intensity that he will seek 
a fight with bite and blow, and when the combat is over will 
strut back to his little flock and proudly cackle over his 
triumph. The small boy may defend himself either by 
showing a pair of clean heels or standing his ground armed 
with a heavy stick twice as long as the gander's neck. If he 
succeeds in landing a vigorous side swipe on the neck, he 
may knock out the hiss, but the gander will put on a good 
face and cackle all the same. 

With such environment, and other diversions perhaps 
more attractive, to which I will refer later, my boyhood 
life ran its course of joyous but heedless pleasure and happi- 
ness from birth to the death of my mother, 1828-44. In 
fact, I might with greater accuracy and propriety reduce the 
limit to 1837, when I began schoolboy life by going to a 
country school five miles distant from the homestead. It 
was during the early period, before the days of school recita- 
tions and night school-lessons at home that the frivolous but 
absorbing pleasures and pastimes of the country boy so in- 
delibly impressed the mature man with the vivid recollec- 
tions of his young life on the farm and in the open fields, 
sniffing the air fragrant with fresh vitality for the breath of 
growing life, varying, with change of season, in the bouquet 
of growing and blooming plants, of ripening and harvested 
crops, of autumnal fading and falling foliage, and winter's 
frosty and chilly blasts that swept the landscape and covered 
the earth with snow and ice. The seasons of hay-making, 
grain-harvesting, and corn-shucking were times of special 
and busy delight, during which, at remitting intervals of 
brief or long duration, as the interest might persist or ooze 
out in tire and sweat, I would take a share with a wooden 
fork in thinning the rows of falling grass after the scythe, or 
carrying sheaves of grain to the shocking-places, or husking 
corn in match to count first a fixed number of red grains 
of corn, which usually continued too long for the joy of 

3 



34 A SOUVENIR. 

winning and became labor without fun. In spring and fall 
fallowing- times I would follow the plough searching for worm- 
bait wherewith to angle the streams with rod, line, and hook; 
and ride back to the stable at feeding-times the beast of work, 
which might perchance once or more, with a shrug and shake 
of the body from mane to tail, slide me off his bare and 
sweating back ; or at other times stroll the pathless woods 
among primroses and violets, listening along the ramble to 
the matching and warbling birds, and gathering nosegays of 
scented herbs and wholesome wild flowers to decorate the 
vases on the parlor- mantle and sideboard, or selecting plants 
to transplant in the flower-beds on the front lawn ; and on 
other opportune occasions plucking fruit hanging in luscious 
ripeness from the bearing boughs of laden trees, or invading 
the forbidden patches and bushes of the berry and succulent 
fruits that had been so carefully cultivated for table and 
other domestic uses ; or, with youthful rashness, chasing 
snakes to free the captured frogs from their venomous 
jaws; or, perchance, when the querulous bullfrogs about 
the muddy ponds were bellowing in croaking cadences, 
would take my chance with bean-shooter at bull's-eye gam- 
ing ; or, perhaps, at late twilight catch toads luminous with 
fireflies gobbled up and guzzled down, but always careful 
to avoid verrucal infection. It was a prevalent superstition 
that seed -warts were due to the inoculation with the renal 
excretion of toads, and that the most effective remedy was 
strangulation with horsehair ligatures and dropping the 
seeds at some road-crossing whilst chanting the refrain 
" Warts, warts, please leave me and take the next passer-by." 
And in later months, with bag and pockets, hunting chest- 
nuts, chinquapins, hickory and hazelnuts, to store away for 
winter ^festivities and nights of bellyaches and castor-oil, 
which even now make me shudder with fear lest some grip- 
ing pain may disturb the peaceful sleep of declining life. 

The mere citation in a running summary falls far short of 
giving expression to the fascination of such pastimes. ISTo 



SKETCH OF EARLY LIFE. 35 

one but the country boy on the farm, who, with bared feet, 
has followed along the fresh furrow of the fallow plough and 
caught the slimy earth-worms as they twirled into or out of 
their tortuous channels in the upturned sod, can appreciate 
the fulness of such pleasure. There is something in the 
odor of newly turned earth, in the sensation to the tramp- 
ing bared feet, and the deft grasp of the worm-bait seeking 
escape that adds to pleasure such exhilaration that thrills 
the country boy with the ecstasy of delight. Not less en- 
chanting is a ramble through the woods during Nature's 
budding season, when the balmy air is laden with the fra- 
grance of leafing and flowering undergrowth and stately 
trees, the woodland ways are shrouded with the changing 
and dancing shadows of waving boughs freshly budding 
with new flowers and whispering leaves, the birds are busy 
building their nests and singing to " call forth paramours/' 
and the welcome spring is painting the forest with blossoms, 
filling the air with perfume, and covering the earth with 
splendor. 

The fishing excursions were not uniform either in their 
pleasure or results. The glowing anticipations of a catch 
were not always realized ; in fact, sometimes the fishing 
tackle and disappointment were all that was brought back 
after a half-day's exposure to the burning rays of the sun 
on a hot summer day. The patience and forbearance of a 
lover of the sport are not easily disturbed by disappointment, 
however much friends may twit him for his failure. After 
a night of refreshing sleep he will be as ready to repeat the 
day's pleasure as if the catch on the previous day had filled 
full the measure of his gratification. The youthful angler 
is, perhaps, not so patient and persistent in compensating 
the disappointment and failure of to-day with the hope and 
confidence of success of to-morrow, as he who has followed 
through several, and perhaps many, decades the pleasure and 
recreation of fishing, and can stand, day after day, in patient 
silence under the burning sun on the fishing-bank, with 



36 A SOUVENIR. 

angle in hand, watching the bending reed from which hangs 
the baited hook, without a single pang of regret, even though 
the fish refuse the treacherous bait. I did not belong to the 
obdurate class of Walton's disciples, but fished to catch fish. 
A good catch more than compensated for muddy and torn 
clothes, dirty hands, sore feet, and hunger; but no catch, 
and a poor catch only less so, brought retributive discontent 
with tire and dumps, which were not so completely obliter- 
ated by a night's sleep that I would seek the repetition of 
the excursion the next day. When the day was favorable, 
and the fish were plenty and eager for the bait, the pleasure 
was fully up to the standard of highest enjoyment; but when 
the stream was swarming with schools of mullets the hook 
and line was slow sport to mullet-catching, which was ac- 
complished by driving one or more schools along the fish- 
ways up stream and then obstructing the way with stones, 
brush, rails, or other material at hand, so that the fish could 
not pass, and then going above them and with long poles 
thrash the water all along behind them until a shoal was 
reached, usually alongside of the obstructed fish way. When 
landed on the shoal in frightened effort to escape pursuit, 
they could be gathered up by the hands in such number as 
would fill our strings and nets. It was not, perhaps, per- 
fectly fair, but it brought fun and caught fish in abundance, 
and thus filled the measure of the angler's highest aim and 
sport. 

Snake-hunting was not an attractive sport, but snake- 
killing was a desperate duty. Country boys do not like 
snakes, nor are they willing to acknowledge failure to kill 
the reptile when the opportunity obtrudes itself. A snake 
at bay, coiled upon itself, with head erect, glistening eyes, 
and sissing tongue, showing fight and threatening attack, puts 
valor at discretion, and the combat rages at safe distance 
with stones, sticks, and other missiles until the reptile is 
too much injured to continue the fight and then the killing 
is completed, or it escapes by quick movement and is not 



SKETCH OF EARLY LIFE. 37 

pursued. But when the snake is caught with the hind legs of 
a frog projecting from his jaws the sport of a chase may not 
be less rash, but it is freer from caution and more conducive 
to the satisfaction of killing. Such sport may be lively, but 
it is not fascinating. 

The summer environment and amusements were the con- 
tinuation of the outdoor life and activities of springtime, 
to which were added the temptations and ravishments inci- 
dent to grain-harvesting, hay-making, fruit-ripening, and 
abundance of garden vegetables. Such pastoral pastimes 
and appetizing inducements supplied ample opportunities to 
the country boy for healthful exercise and such enjoyment 
as made life in the open air a fairy tale of joys. A tramp 
through the stubble fields, along the banks of the meadow 
streams, over the forest ways, and under the orchard trees, 
with here and there a rest in shady nooks at full length upon 
the cooling earth, with three hearty meals every day, made 
him as happy as the days were long. It was the season of 
sweltering heat, bared feet, light clothing, straw hats, bathing 
and swimming in the shallow ponds, basking in the sun- 
shine on the sandy shoals, and paddling up and down over 
the rocky bed and through the splashing rapids of the crys- 
tal stream. One must have the experience to realize the 
rapture of such pleasures. They come and go in daily suc- 
cession free from surfeit and ennui, adding with each after- 
coming day new and queer phases to the delight that make 
the summer life of the country boy on the farm a continuous 
series of high-jinks, sport, fun, and frolic changing with the 
whim and freak of boy nature. 

His life of out-door activities, diversions, recreation, and 
play developed very rapidly the intuitive faculty of self- 
adaptation to environment and to the current and changing 
conditions of season, weather, heat, cold, and wet. He was 
not trammelled by coddling parents and the slavish restraints 
of society and fashion. His free and easy-going natural 
life led him along the line of nature's allurements and 



38 A SOUVENIR. 

enjoyments, and his quick and quaint perception of the 
crude pleasures of farm-life made "the quips and quirks 
and wanton wiles" a train of pastime and joy. 

With the autumn came new scenes and occupations, not 
less active and enjoyable, but less emotional and interchange- 
able, pertaining more to the practical and business aspects 
of life than to impromptu and sentimental entertainment. 
The plundered orchards, russet forests, falling leaves, seared 
fields, lengthening shadows, melancholy twilights, and wail- 
ing winds were nature's warnings to prepare for the coming 
winter festivities. The poultry-yard needed attention that 
the fattened fowls might be in condition for a ready market. 
The gun needed furbishing and a new flint, and the powder- 
flask and shot-pouch refilling. The hunting-dog must have 
practice to quicken his scent, and the beagle-hounds training 
for the rabbit-chase. The rabbit boxes and gums needed re- 
construction. Squirrel-hunting, partridge-shooting, and rab- 
bit-chasing were lively and attractive sports, but the econ- 
omic and penny-making industries could not be neglected. 
The Christmas season was coming around again and time 
was growing shorter by counting the weeks passing fast. 
The purse was in distress, Christmas came but once a year, 
and must be provided for " by hook or by crook." 

Nut-gathering was a productive, though not a profitable 
pleasure. Perhaps a whole day, for which Saturday was 
preferable, would be spent in thrashing down and hulling 
bushels and sometimes barrels of black walnuts to store away 
and to barter for Christmas fire-crackers. Black walnut 
trees were numerous and bore very abundantly, but home 
consumption was large and the market was quite frequently 
overstocked. Town people preferred the almond, shellbark, 
and pecan to the more indigestible and less flavored black 
walnut and hickory nut. The hickory (king nut) was 
usually gathered after falling, but the walnut trees stood in 
the open fields or in clumps, and could not be safely left for 
falling-time, because of the risk of losing the fruit. Other 



SKETCH OF EARLY LIFE. 39 

boys and unknown intruders were quite as diligent in 
gathering their supplies. Nut-bearing trees and bushes 
scattered about the farm out of the way of o^irect and con- 
stant observation were common property, and the fruit was 
the price of vigilance and industry. To secure a monopoly 
or the larger part of the product, it was necessary to thrash 
many of the trees. After hulling, the nuts were dried in the 
open air and then stored away in some dry place for use. 
The consumption of walnuts by a country boy at his inter- 
meal feasts, and especially in preparation for bedtime, is 
only comparable to the quantity of corn an adult duck will 
consume if allowed to sip a little water and shake his tail 
feathers during the feeding, or to the quantity of boiled corn 
a fattening hog will eat at a single feeding. Neither will 
ever get enough. The hog possesses one great advantage. 
When he has swallowed until he cannot hold another grain, 
he will sit upon his tail and scratch the roof of his mouth 
with one of his hind toes until he vomits, and then return 
to the trough and eat with the energy of a hungry beast. 
The tasteless greediness of the domestic duck is a phe- 
nomenon. The capacity of a country boy for nuts is not 
less remarkable. He eats until stiff with fulness, and then 
looks over the empty hulls for the bits of kernels left behind. 
Every season had its pleasure, and the winter-time had its 
special line of in-door and out-door amusements, not, per- 
haps, so well adapted to the restless and changing taste of 
the country boy, who lives and thrives on pleasure, plain 
food, and sound sleep ; nevertheless, not without interest and 
consuming recreation. Coasting down long hills and away 
into the valleys below, until brought to an abrupt stop by 
pitching into a frozen stream or against some obstruction, on 
a rudely improvised sled, was just as wildly attractive then 
as now, and bruises, contusions, cuts, and scratches, with torn 
trousers and jackets out at elbows, were just as common con- 
comitants ; but there were no vehicles to drive across our icy 
descent, nor crowds of idle and wild poor boys without sleds 



40 A SOUVENIR. 

to jeer and bawl at our ludicrous mishaps and, sometimes, 
sharply painful cuts and other minor injuries. We were 
sufficiently prudent and philosophic to lick and hide the 
wounds and coarsely sew up the tears and rips of clothing 
before returning to inspection, lest the edict of prohibition 
should be issued at early breakfast the succeeding morning. 
Then, too, we had our field ponds and other collections of 
water for skating on shoes, and then tramping far away to 
the cobbler to have them revamped and rehalf-soled ; and 
perhaps, on other days, when the wind was cutting cold and 
the earth and ice-ponds Avere clad with snow, would rollick 
about and sniff the scented air of green wood burning in the 
forest, where the woodman was felling timber and chopping 
back-logs and smaller fuel for the winter fires in the dwell- 
ing and greater fires in the quarters, and where old Uncle 
Cato, with maul and wedge, did rive huge logs into rails, 
and, at resting intervals, piped himself full of smoke with 
such relish that blisters on his tongue did neither hurt nor 
disturb the solemn mirth of his tales of " Jack the Giant- 
killer." Rabbit-trapping in boxes and gums was, however, 
the most intensely absorbing seasonal sport. To run at early 
sunrise in high expectation and return in gleeful success 
with the living trophy held tight in hand was fun in fact ; 
but when the traps were empty, or, before I had learned 
how to garrote him, old " cotton tail " had escaped by jerk- 
ing loose from grasp and darting at double-quick away 
through the undergrowth, the gait of return was slow and 
careful, in thoughtful preparation of an excuse for failure 
to bag my game, and then, at late sunset, having forgotten 
the morning disappointment and chagrin, with rekindled 
hope, I tramped the woods and ravines where timid rabbits 
did lightly tread the tiny paths, to bait the traps with fresh 
food, and set the triggers for easy fall, that I might insure my 
catch to replenish my Christmas and Fourth-of-July pecuni- 
ary resources. Rabbits in those days were worth in open 
market from five to ten cents per carcass with skin intact. 



SKETCH OF EARLY LIFE. 41 

The later years of the country boy were not so exclusively 
limited to rabbit catching, but were quite often diversified 
with gunning in general for game at large, but more espe- 
cially with partridge-shooting, which required more skilful 
handling of the fowliug-piece, and was stupidly dull and 
fatiguing to the inexpert gunner. There were many other 
by-plays equally enticing and full of frolic and merry-mak- 
iug, but less engrossing and more evanescent in their hold 
upon the exuberant impulses and restless spirit of the healthy, 
well-fed, and vigorous youth. Tops, hops, kite-flying, mar- 
bles with hives and fen hives for fun or for keeps, and for 
knucks, mumble-the-peg, quoits with pennies or with blocks 
or stones, ball at bat and sky-ball, riding piggy-back, play- 
ing ducks and drakes, and other athletic sports of the rough- 
and-tumble sort, devised on the spur of the momeut, and 
not always free from a fight at finish, were held in reserve 
to drive away dull care. 

It is strange, nevertheless true, that the location now 
known as Glen Echo was a part of my rabbit-trapping and 
hunting-ground, over which I have tramped through wind, 
cold, frost, and snow to my traps and in search of other 
game. It was then a rough and neglected region and known 
only to those who might tramp the pathless forests and 
broom-sage lowlands with dogs and gun to trap or chase the 
rabbit, or bag other game which, at times, sought refuge in 
the lonely forest and secluded valleys and ravines. It had 
not then engaged the speculative conception of the human 
mind that land that could not find a purchaser at five dollars 
per acre would ever be subdivided into town lots and sold 
by the square foot at prices far beyond the wildest dream of 
the most visionary and reckless theorist in future gains and 
profits. And even now, as I drive along the conduit road 
which bisects this region, which recent romance and poetry 
and financial wreck have made as famous as the South Sea 
Island bawble, I cannot realize the lavish and fruitless 
waste of money, taste, and enterprise in speculative future 



42 A SOUVENIR. 

that decorates the lonesome hunting-ground of my youth. 
Glen Echo with her mansions on the sloping hillsides, her 
great Chautauqua buildings falling to ruin, the numerous un- 
occupied cottages on the level where broom-sage and poverty 
grass grew in luxuriant evidence of the poorness of the 
soil, and the driveways over the rugged hills and through 
the primeval forest, is more desolate than when the rabbit, 
opossum, woodcock, and other game abounded and made 
merry the sportsman with his gun and dog. 

The Christmas festivities began the day before with busy 
preparation for the enjoyment and merriment that were to 
obliterate all the sorrow of the year soon to close with the 
coming of the welcome New-year Day. The final act of 
readiness consisted in the filling of the stockings of the do- 
mestics hung to the chimney -jamb, and arrangement of the 
gifts so that each could be conveniently and orderly pre- 
sented to the person for whom intended. Then to bed to 
sleep through dreams of pleasure until the break of day, 
when the frost was gleaming in the starlight, the air was 
keen and crisp, and the great back-logs were simmering and 
fuming at each end, whilst the smaller fagots, piled thick 
and high up in the fireplaces, were glowing with living 
coals of fire, and the roaring flames rising higher and higher 
up the chimney were filling the rooms with the warmth and 
mellow shadowy light of the merry Christmas fires, the slaves 
came knocking at the windows and doors to catch missus 
Christmas gift and to offer some token of their respect and 
good- wishes. Old Cato wanted a new wammus ; Frank, a 
new silk hat to don when on the carriage-box ; Lewis, to- 
bacco and pipe, and a little grog to limber up his stiffened 
joints ; old Charity, a new turban to decorate her kinky 
head ; Yi, a new white apron ; others, flour, sugar, molasses, 
eggs, butter, and spices with which to make cakes and pies ; 
and others of the younger set articles of wear, according to 
their taste and dress fancies. 

Whilst the maids of honor, who had nodded around the 



SKETCH OF EARL Y LIFE. 43 

hearth, waiting the first streak of daylight to rifle their 
stockings of the precious promises for past good behavior, 
were distributing the gifts that made the receivers clamorous 
with joy and tumultuous with thankfulness, I took delight 
in throwing all around and about at random aim the lighted 
firecrackers, thus adding such consternation to joyous tumult 
that made the scene seem like a combination of paradise and 
pandemonium, commingling delight with uproar in such 
innocent discord that made the welkin ring at dawn of 
Christmas Day and filled the measure of my fun to my 
heart's content. All this was the prelude to that wider 
scope of enjoyment which made Christmas Day par excel- 
lence the day of joy and merriment. It was everybody's 
day for pastime, fun, frolic, feast, and mutual interchange of 
good-will and bonhomie. The slaves feasted to the gratifica- 
tion of their taste and the fulness of their appetites. Cato 
preferred opossum baked to his liking, another roasted pig 
flavored with some favorite herb, but turkey was the most 
popular flesh. Old Charity added Maryland biscuit and 
mince-pie to her dinner feast, and Yi with her family sat 
down to a table abundantly supplied with such luxuries as 
she had carefully prepared for the occasion. Aunt Hannah 
sought surcease in a glass of apple toddy made of red- 
streaked apples gathered from the old orchard trees on the 
River farm, which she and Uncle Will had so carefully 
protected in years gone by, and from which they had an- 
nually through a long period of time gathered the fruit. 
The day's festivities concluded with a shuffle hoedown dance 
to the music of the fiddle and bow and patting juba, while 
the whole company united in singing the chorus of some 
popular negro melody. 

The country boy's Christmas jubilee continued until the 
last ember of the back-log ceased to glow. All his hopes, 
anticipations,.and preparations were summarized in the joy 
of the occasion, and as time passed on through the dreary 



44 A SOUVENIR. 

winter months of the new year his recollections of the inci- 
dents added fulness and completeness to his pleasure. 

The winter evenings were usually very enjoyable, and 
most often passed in family reunion around the bright and 
glowing green woodfire in such chat and talk as the current 
events and play-doings might suggest, with such good advice 
and admonition as the good mother might choose to offer, 
sometimes in warning and at other times for our guidance 
and instruction. A sharp lecture, with cogent expression of 
disappointment and dissatisfaction, would occasionally arouse 
us from drowsy nodding with fervid exclamations of "I 
didn't mean to do bad," and equally clamorous negative 
"Won't do so no more," and then in sober sorrow, quite 
often highly flavored with penitent delight at escape from 
the spanking slipper, of which I got the bigger boy's share 
or all, to bed to sleep away both hurt and penitence as well 
as memory of good promises made. 

Those less fortunate, who have not passed their childhood 
and youth on the farm in the days of woodfires and tallow- 
dips, cannot appreciate the primitive and simple pleasures of 
such surroundings, with all their suggestive and lasting re?- 
membrances. They cannot realize the fervid zeal of a whole 
evening's study of the grim but radiant visages, some in 
forbidding grimace and others in less portentous and more 
sightly profile, in the embers glowing on the hearth or hang- 
ing in loose bundles to the burning fagot that seems just 
ready to part in the middle and topple, sound end down, 
over the heated fire-dogs. Nor can they be so keenly sensi- 
tive to the delight with which the rural champion will watch 
and closely snuff down the glimmering flame and bet on 
speed of melted drops of grease slowly running down the 
uneven surface of the tallow-dip to collect at flange of can- 
dlestick in flakes of cold tallow. Nor, again, when rainy 
days had come or the shingle roof was covered with 
snow, to watch the flame bursting from the chimney-tops 
from lighted sheafs of straw pushed into their throats, to 



SKETCH OF EARLY LIFE. 45 

burn them out in safety from the danger of setting the house 
on fire. 

Just here I must turn away from such incidents to inter- 
polate a reference to the thrilling circumstance of my first 
observation of an aurora-borealis, now sixty or more years 
ago. It was a night with crisp and fast moving wind, and 
there came a sudden and violent knocking at the door to call 
the family to view the appearance in the heavens, luminous 
with a great wide stream of red, with radiating, irregular, 
and dancing streaks, fading in color from base to point. All 
around and about the dwelling had come from their quarters 
the slaves, old and young, men and women, in such state of 
consternation as boys never saw before. Some in dishabille, 
and others in hasty dress, with children in their arms, who, 
with others, stood in ghastly terror, with uplifted arms and 
reverent acclaim prayed for protection from such bloody 
carnage and destruction as their superstitious souls and de- 
throned reason had augured from the ill-omened phenome- 
non. Whilst this thrilling scene was passing I stood with 
throbbing heart and choking fear, clinging to my mother in 
the doorway, who, in a few calmly spoken words, bade them 
go to their quarters and rest assured that no harm would 
come to them, and, with that confidence that comes from high 
esteem and love, they accepted her assurance and retired in 
peaceful misgiving of her prophetic words. 

The wood-pile at the farm-house was an object of general 
interest when the earth was covered with snow and sleet, 
the roads were blocked with drifts, the streams were frozen 
over, and the sharp and penetrating wind was howling under 
the eaves. The choppers were busy, and the carts and 
wagons, with drivers on foot, hurried from the woods, where 
the axe- men were felling giant trees, to the wood-pile, where 
others were chopping the rough and crooked branches into 
shorter or longer back logs and other pieces in length to suit 
the great and smaller fireplaces. The wood-pile was kept 
heaped high with trunks and limbs' in all sorts of knotted, 



46 A SOUVENIR. 

crooked, straight, round, and split firewood, in irregular 
lengths and sizes, with chips large and small, thick and 
thin, from bark to heart, with such fresh woody odors of 
green wood kinds, gathered in heaps for kindling, or left to 
sobby in snow and rain. With little to do and much time 
on hand, it was our pleasure to be as near at hand and in 
the way as the swing of the axe and flying chips and slivers 
would permit, or, perhaps, climbing up one side and down 
the other of the huge pile or riding straddle some project- 
ing bough that would swing up and down, and then, with 
torn clothes and many scratches, run home to get a snack of 
yeast bread and sugar-house molasses, and to dry and warm 
the hands and feet stiffened with wet and cold. The wood- 
pile, meal and flour bins were objects of anxious inspection 
and inquiry during such inclement and stormy seasons of 
winter's worst weather. 

During such stormy weather the farm and public roads 
were sometimes so obstructed with snow and ice, and in 
rainy and thawing seasons would be so soft and deep with 
mud, that hauling and horseback-riding would be impossible. 
The shoeing of oxen was not in vogue, and only the riding 
and driving horses were kept shod. To avoid the .discom- 
forts and inconveniences incident to such conditions it was 
necessary to keep on hand large supplies of flour, meal, 
wood, and other but less important articles of domestic 
necessity which could only be obtained from town. At 
such times long sweetening would be utilized as a substitute 
for sugar, and on a pinch roasted rye could be mixed with 
pure old Government Java coffee, from which a fairly palat- 
able beverage could be made. The meal-supply was sup- 
plemented with hominy. To prepare this very popular 
article of diet and substitute for bread great care was taken 
in selecting ears of corn with well-filled and flinty grains, 
from which the small and ill-shaped end-grains were sepa- 
rated by shelling them separately. The grains from the 
central portion of the ear were then put into a wooden 



SKETCH OF EARLY LIFE. 47 

mortar and beaten with an iron pestle until broken into 
small pieces and denuded of the outer covering, and then 
winnowed to separate the chaff from the broken fragments. 
As thus prepared it was boiled in an iron pot until thoroughly 
cooked, and stored away in the larder for use, either warm 
or cold, with milk or butter, or in cakes either fried or 
baked. Hominy could be used as a vegetable or as a sub- 
stitute for bread or cornmeal in a great variety of ways, 
and was a very common article of the diet of a farmer's 
family. The present methods of preparing small hominy 
and grits by machinery were unknown at that time. 

The wood-pile was more often than the larder the object 
of anxious solicitude. A half-dozen great fires in huge fire- 
places burning continuously night and day consumed a large 
quantity of wood. With a rapidly diminishing supply and 
complete blocking of the roads and ways the danger of a fuel 
famine became very threatening. To meet such exigencies 
hand-sleds were gotten in readiness, to which ropes were 
fastened, by which the slave laborers and wood-choppers 
could draw enough wood to keep the fires going until the 
blizzard subsided. 

Hog-killing time was the carnival season of winter plea- 
sure, with its broiled pig-tails, roasted sparer ibs, home-made 
sausage flavored with garden herbs, crackling Johnny cakes 
and fried chitterlings. But these were the delicious if not 
gluttonous products of that exciting custom, which began at 
dawn of day with lighted open-air fires to heat the stones or 
pieces of old iron to boil the water in the scalding-hogshead, 
in which to soak the porkers when the squeals had hushed 
and blood had ceased to flow, and then, with easy rubbing, 
clean the hide of hair, and hang, head down, to dry and cool, 
butcher and carve, and salt away for boiling with cabbage 
and potatoes, for farmer's food and sustenance. Some may 
shudder at this narrative of cruel pleasure ; but, nevertheless, 
it was brimful of excitement and such good eatings as made 
country boys grow fat and cheery. It was hunkydory. 



48 A SOUVENIR. 

The thrifty farmers in the neighborhood raised hogs and 
cured their own bacon in quantity sufficient for their own 
use, with some to sell. Some of them took special pride in 
the preparation of the hams. The methods differed but little, 
but the result in flavor, color, and tenderness excited com- 
mendable rivalry and considerable boasting. Late in the 
fall, after the corn crop had been safely stored in the crib, 
the porkers were penned and fed on corn in the ears, with an 
occasioual feed of cornmeal porridge. When fattened suffi- 
ciently they were butchered as before described. 

A smoke-house, sometimes called a " meat-house," was a 
necessary appurtenance of the farm. It was usually located 
near the dwelling, and built of logs chinked with stone and 
mud made of clay and straw. The roof was high-pitched 
with shingles of white-oak wood. The roof-room was ar- 
ranged with cross-pieces, to which were fastened iron hooks 
upon which the pieces of bacon were hung by loops made of 
narrow thin white-oak splints. The splints were pierced 
through each piece at some selected point along the edge, and 
tied in a twisted knot. When the hanging up was completed 
and the dripping of brine had ceased a dull fire of hickory 
wood was kept burning on the dirt floor, to make smoke, 
until the bacon was sufficiently smoked. Some left it hanging 
until each piece was needed for cooking, others cut down 
some parts, especially the hams, and stored them away accord- 
ing to their methods of curing bacon. It was the care in 
butchering and curing that gave to the Maryland and Vir- 
ginia hams such high reputation. When I came to this city, 
and for many years afterward, the supply of Maryland hams 
on the market was insufficient for the demand. Many per- 
sons would not purchase for their own tables any other kind. 
Now it is difficult to secure one, except as a special favor 
from some farmer w T ho may continue to cure his own bacon 
according to the ancestral method. 

Herring-catching time, which occurred annually during 
April and the early part of May, was another season of 



SKETCH OF EARLY LIFE. 49 

unusual excitement and enjoyment. It was the custom of 
the farmers to drive their wagons to Georgetown, w T here they 
purchased the herring by the thousand from the boats which 
brought the fish from the "fishing-landings" down the Poto- 
mac, where they were caught in seines in very large quantities ; 
and when the wagons returned home everybody that could 
handle a knife was pressed into service to prepare the fish 
for the brine-vats, from which they were in a few days taken 
and packed in salt to remain until needed for food. It was 
a common country saying, how true I do not know, that 
fresh herring made country boys proud and saucy; but I do 
know such food made them feel good. Herring-time was 
fish galore, and for days, perhaps weeks, the changes of fish 
food were many : first broiled fresh herring, then corned 
herring broiled, next fried salt herring, and, finally, broiled 
smoked herring, until one's contentment was complete, and 
saucy pride had lost its spirit in digestive ennui. 

Sheep-shearing was another interesting annual occasion. 
It took place in June, when the red clover and the roses 
were in bloom, and the butterflies in myriads crowned the 
fragrant flowers, "extracting the liquid sweet." At early 
morning, when every herb, leaf, and flower w T as wet with 
dew, the flock was driven into the barnyard, and such num- 
ber was selected as would occupy the shearers during the 
day. Each one of these in successive order was caught, tied 
to prevent kicking, and placed upon a bench, when the 
shearers, with great steel shears, beginning on the abdomen, 
clipped the fleece intact so closely from the skin that one 
could hardly see where the wool did grow. The shearing of 
the flock having been completed, the wool was washed, dried, 
packed, and sent to the carding-mill, w r here it was made into 
rolls for spinning into yarn, which was dyed in such colors, 
usually bright, as were needed, and then, with a pattern 
mostly in stripes, sent to the weavers to be woven into cloth 
for servant's wear. Some of it was sent to the woollen-mill to 
be woven into " full cloth," a choicer kind of cloth than the 

4 



50 A SOUVENIR. 

ordinary country material, for suits and overcoats for special 
wear. 

The country weavers were a lot of old, wizened spinsters, 
as ugly as a mud fence, who dressed during warm weather in 
blue-striped cotton home-made material, and in cold weather 
in gayly striped linsey-woolsey, wore shoes down at the heels, 
combed their hair at such irregular times as suited their con- 
venience, and washed their faces so seldom that no one ever 
saw them looking clean. They earned a meagre livelihood 
by plying the loom, and seemed to enjoy the life of work and 
poverty. They all belonged to one family, and to some race 
different from any known to the neighborhood people. Some 
good people were cruel enough to say they were a cross of 
the Indian with the orang-outang. As the old spinsters had 
passed the age of fertility, I suppose the race has become 
extinct, and handloom-weaving has ceased to be a food- 
earning employment. With the decadency of such domestic 
industries the spinning-wheel has also disappeared from 
common use, but, strange to say, it has become a drawing- 
room ornament to illustrate the primitive methods of many 
families claiming the proud distinction of colonial descent. 
I must add, in this connection, that my yarn stockings, not 
hose, as now worn, and long comforts for wrapping around 
the neck, and ear-protectors were knit of yarn spun of wool 
dyed in the fleece. 

But such young, sportive, and play-life, with such " well- 
springs of pleasure " and fun in work and deviltries, like 
true love, did not always run as smoothly in such boyhood 
activities as it appears in printer's ink. It had its ups and 
downs, grumpy spells, sullen and bad temper, and coarser 
displays which might invoke more lasting inhibitory re- 
minders. We were not, in the parlance of the present time, 
very bad boys, but had to stay indoors and take the physic 
prescribed for such infractions of life and duty as vary the 
life-history of boys in general, all the more often committed 
when they added zest and spirit to pleasure and pastime. 



SKETCH OF EARLY LIFE. 51 

" Variety from which fresh pleasures flow " was not infre- 
quently pierced with sorrow. The setting hen would not 
hatch the eggs ; the favorite duckling would topple over and 
die ; the pigwiggin chicks would have the gapes and die not- 
withstanding fumigation with the smoke of burning tobacco- 
stalks, and great, big, round tears would roll down the cheeks 
at their burial. The marble thumb would go wry, the aim 
would miss, and the other boy would hold the keeps or shoot 
the knucks. Green apples and gooseberries would give the 
mulligrubs ; and stone-bruises on one heel, with a " blood 
bile" on the buttock of the opposite side, would keep one 
busy in bed brushing away the flies from the cornmeal poul- 
tices and sugar-and-soap drawing-salve, very much to the 
detriment of good temper and peaceful equanimity ; and pain, 
griping with fluxes, and throbbing with " biles," which 
when squeezed to dislodge the cores would reach high up the 
scale of crying agony. The fish would not bite, and the 
mullets would hide in deep water, and the storm-swept 
streams would swiftly flow with water too muddy for swim- 
ming, and a " fit of the tantrums " would finish the day of 
such lugubrious sport. In brief, disappointment and sorrow 
came when neither expected nor wanted, and made one limp 
with the dumps and choky with fret, and roaring and pierc- 
ing cry would rend the air until the " timely dew of sleep " 
brought back dreams of joys and pleasures new. 

Buddy Gus, as my half-brother was familiarly known, 
was an inveterate tease, and would occasionally provoke my 
good nature to fierce wrath, with a scrimmage of flying corn- 
corbs, wood chips, stones, brickbats, or other convenient 
missiles. His rigs, for the most part, related to some good 
turn done to me by some one of my mother's spinster chums, 
either of the Melissa Wallace kind, fair, fat, and forty, joc- 
und and round, or of the Polly Jingle sort, thin, shrivelled, 
and whining, to whose houses I had been sent on some er- 
rand, and who had treated me with sugar-plums and cakes, 
or filled my pockets with almonds and raisins, of which he 



52 A SOUVENIR. 

would rob me and then banter and jeer me with some well- 
made-up story of m y affectionate regard for the kind-hearted 
donor, or, after having eaten all my bonbons, would taunt 
me in broad humor with the joke that they were old, dry, 
wormy tidbits kept to give the nigger boys when begging 
for some toothsome dainty, and so touch my pride that a 
fight would soon follow. But whilst Buddy Gus would have 
his fun at our expense he was never a talebearer, and we 
always greeted his coming home from school and followed 
him in his long rambles through the fields, over the hills, and 
along the ravines, where his pleasure might lead him, and told 
him in free confidence of our play-doings and deviltries. 

After he left school and took charge of his farm he was 
more reserved but not less kind, and was more concerned in 
my night lessons than in my amusements, and. took much 
care to help me with my studies. To his assistance I owed 
much of my rapid progress. 

He sometimes permitted, and even invited, me to accom- 
pany him on foot or on horseback on his visits to young 
ladies, because I was very useful with play and romp to de- 
coy the small boy and little girls, that he might chat and 
gossip at leisure ease, and with more freedom, and make love 
to the bashful maidens of sweet sixteen, and when, on ram- 
bles along the roads, my approach came dangerously too 
near, he would send me ahead to drive the cows from the 
roadside or frighten the shoats from their wallow in the 
roadway, for then as now young ladies were proverbially 
afraid of browsing cows, and shoats, that awakened from 
sound sleep with a frightful grunt and startling jump, 
scampered away across the field with ears up and tails twisted 
close to their haunches. Such escapades on his part supplied 
me with ready and effective retort, especially when the 
teasing took place around the tallow-dip or before the 
blazing family fireside, when he would take sudden refuge 
in reading aloud the National Intelligencer, the family news- 
paper. 



SKETCH OF EARLY LIFE. 53 

My mother belonged to a class of mothers who believed 
in hardening boys for the struggles of manhood life. When 
we had grown too large for the trundle-bed she built an addi- 
tion to the dwelling on the northern exposure, with great 
windows to let in light and sunshine, without a fireplace or 
any other means of heating, except with a single tallow- dip 
at bedtime, or any convenience for washing and bathing, 
and so far away from the fireplaces that we could not even 
smell the kindling fires. It was so cold in the bleak and 
freezing winter nights that my shoes and yarn-knit stockings 
would freeze so hard and stiff that I would rush with bared 
feet and half-clad limbs and body to the roaring fire to thaw 
them before saying my prayers ; then to the piazza to break 
the ice in the tub in which the servant had toted the water 
from the spring, to obtain the necessary amount with which 
to wash my face and hands, in shivering haste to return to 
the fire and turn from face to back and side to side to keep 
one front from burning and another from freezing. All this 
was in preparation for the jack-rabbit catch, or, perchance, 
to go to see the pigs called from their smoking beds, fed 
and counted. In those days neither pigs nor boys were per- 
mitted to slumber till sunrise. At biting daylight the 
neighborhood resounded with loud calls of pigs to breakfast. 
Of course, the early wash in such cold comfort was more for 
show than for dress ; but at night, when the cook was nod- 
ding with needle and patch in hand, the room was warm and 
water hot, washing and bathing could be completed to one's 
entire and delightful satisfaction. 

There may have been some merit in such process of hard- 
ening, but I did not appreciate it and have not been convinced 
of its wisdom. The victims could not see the good of it. 

The time came when the joyous and profuse pleasures began 
to fade away. Alfred and Tom, our slave companions, a 
year or more older than I, had, like myself, grown old enough 
to assume duties that furnished employment with fewer and 
less varied pastimes. However reluctant I may have been 



54 A SOUVENIR. 

to give up, at least in a great measure, my playmates and 
treasure of amusements, the duty of obedience was inexora- 
ble, and to the country school for boys and girls I had to go. 
Alfred and Tom and old dog " Cash " were relegated to the 
fiercer leadership of a younger brother, who was just loosen- 
ing from the apron-strings under my tutorship, and for 
whose errantry I was partly responsible, both by example 
and inducement. It was well that it was so, for he took 
pleasure in anticipating and making preparation for my 
amusement during the afternoons and holidays. 

The boyhood companionship of my brother William and 
myself is full of cherished memories. He was two and one- 
half years my junior, but soon became my equal in all the 
innocent amusements and deviltries of early life. With a 
more impulsive temperament and keener perception he was 
more than my rival in many sports and joys that made the 
loom of our lives a dream of pleasure new. It goes without 
saying that disagreements and collisions took place, but they 
were momentary, and perhaps passionate explosions of differ- 
ent dispositions that left no scars to impair the completeness 
of mutual affection. His country school-life began just 
before the close of mine, but we were never at the same 
boarding-school at the same time. He was by profession a 
civil engineer, and performed his first field service on a 
Virginia railroad as an assistant in a corps under the direc- 
tion of the late General William Mahone. Subsequently he 
abandoned his profession and engaged in commercial busi- 
ness in Georgetown. He married a daughter of the late 
Henry Dunlop, of Frederick County, Maryland, and died 
after years of ill-health at Aiken, South Carolina, on Feb- 
ruary 18, 1881. 

Alfred and Tom were slave-boys. Alfred was the young- 
est son of Charity Martin, the cook, and was, consequently, 
favored with privileges which the other slave children did 
not enjoy. Charity Martin had been my nurse during my 
babyhood, and, t$ use her own expression, " always had a 



SKETCH OF EARLY LIFE. 55 

warm side for me/' which I was quick to learn and appreci- 
ate. I hold her memory in grateful remembrance for her 
many sly favors and gentle kindnesses. Alfred was a robust, 
round-faced, very black boy, with a wide mouth, shining 
skin, bright eyes, and a merry laugh, always ready for sport 
and very suggestive in play-doings. A dainty tidbit from 
the family table or a share of ginger-cakes or any toothsome 
bonbons would appeal to his highest aspirations, and so filled 
him with willingness and readiness to contribute to my pleas- 
ure and enjoyment, that I always knew how best and most 
speedily to rouse his enthusiasm and startle his brain with 
fresh activities. The promise of a share of my snack upon 
return from some ramble, escapade, or deviltry would add 
such nimbleness to his activity, force to his endurance, and 
joy to his good nature, that my promise secured all the ser- 
vice that I might require. He was ready to open the yard- 
gate for visitors, hold their horses, or fasten the reins to the 
rack and receive the penny-tip which he gave to his mother. 
He could climb a cherry tree as quickly and eat as many 
cherries, with pulp, skin, and pit altogether, and cry as loud 
with the " gripes," as any other boy. He was for a year or 
more my horse-boy, who rode behind me to and from the 
entrance-gate of the orchard farm, and could stone an apple- 
tree and shake a peach-tree with marvellous dexterity, and 
then gather up the fallen fruit and escape while the farmer 
was calling Towser to sic him on. In after-life he was a 
dignified and reputable colored gentleman, and died several 
years ago in this city. 

Tom was an awkward, gawky, ugly, dark copper- colored 
boy, with a knappy head and dirty nose, without emotion 
and less sensibility. He never cared which end went fore- 
most, and always carried a stumped toe or bruised heel, and 
could fall down and tumble about without hurt or inconveni- 
ence. He was the dray-horse and carried the basket or bag 
or whatever else that was burdensome, and could sleep in 
the blazing sun until his nose and mouth got so full of flies 



56 A SOUVENIR. 

that his snoring would awaken him. He was obedient and 
docile, and as subservient to Alfred as to me, and took cuff- 
ing with such laughter as brought out his ugliness in pic- 
turesque depravity. Tom lived at the quarters with his 
mother, who was a voodooist and believed in ' ' tricks " and 
incantations. She would seek escape from work because of 
some lameness or physical disability ascribed to some " trick " 
practised upon her by some old negro whom she did not like. 
Tom had tricks also, but of a different sort, and he got 
tricked, but in a different manner. He cared but little about 
either the sort or the manner in which he got tricked, but 
took the world just as he found it, or as somebody made it 
for him. 

Country boys, like their contemporaneous city boys, some- 
times got sick in those days ; but sickness was actual punish- 
ment, and as absolutely free from coddling, sentiment, and 
sestheticism, as it was slavish submission to the tyranny of 
primitive medicine and hereditary customs of domestic sani- 
tation. It meant the bed in a closed room, with sunlight 
and fresh air shut out, a feather bed with heavy blankets, 
sun-burned water to drink, and food of panado, made by 
simmeriug before a slow fire crumbs of toasted bread in a 
pan of sun-warmed water, chicken-water prepared by stew- 
ing the shadow of some part of a chicken hanging by a 
string from the chimney -jamb, or gruel without salt or season- 
ing of any kind, and calomel to-day followed to-morrow by 
rancid castor-oil, or rhubarb sweetened with Santa Cruz 
sugar, with nose-holding to enforce its taking. Drinking- 
water was carefully prepared by exposure in a shallow 
vessel to the hot sun until it was as unpalatable and sicken- 
ing as the crude custom could make it. Burning thirst, 
with a tongue so dry that a cross and fretted boy could not 
utter his discourteous maledictions, was far preferable to 
such potations. Such was the ordinary regime of medicine, 
sanitation, and feeding, to which were sometimes added vene- 
section and sweating-teas, boneset for boys and tansy for 



SKETCH OF EARLY LIFE, 57 

girls. As a special favor, at the retributive suggestion of 
some old woman who had buried a half-dozen children, 
ginger or sassafras tea was substituted, especially in spring, 
when the succulent sassafras was in bloom. Diseases were 
not so inviting either in variety or prevalence as nowadays. 
Stumped toes, stone-bruises, biles, and flux, the latter espe- 
cially in green-apple times, and belly-ache when nuts were 
ripening, were the most common maladies in the summer, 
and in autumn seasons sore noses, chapped hands, in winter 
chilblains and choking coughs. Typhoid fever and diph- 
theria were not known then, but chicken-pox aud whooping- 
cough made their usual migratory excursions, preparatory to 
more rapid and healthful development. For nose-colds and 
choking coughs " stewed rabbit " and goose-oil with brown 
sugar were favorite remedies. When the nose-colds did not 
quickly yield, rubbing of the organ with the melted drip- 
pings of a tallow-dip was very efficacious. Bilious fever 
was the dreaded endemic and invoked the highest attainment 
of medical art in bleeding, calomel-dosage, food-attenuation, 
and drinking-water sun-purified ; bleeding at the elbow- 
flexures, in the jugular, and as a unique resort at the ankle. 
I am still alive bearing these exsanguinating scars in memory 
of the skill and dexterity of my country physicians, both 
old practitioners, one of whom was a graduate and the other 
a first-courser of the University of Pennsylvania. The fore- 
going is not a fancy sketch, but the statement of personal 
experience as I distinctly recall it to-day. 

Blood and blind boils, technically known as furuncles, 
were most prevalent during the blackberry season, and were 
attributed to excessive ingestion of the succulent fruit. They 
were considered blood-purifiers, and each one was valued at 
five dollars. I would have willingly sold all of mine at a 
shilling apiece, with thanks. They always seemed to prefer 
the parts where they would occasion the most inconvenience 
and greatest pain ; in fact, I never found, except on some- 
body else, a convenient place to have one. Stumped toes 



58 A SOUVENIR. 

and stone-bruises were the necessary results of barefoot 
tramping and stick-horse prancing. The great toes and 
heels were the usual localities for such painful contusions. 
Barefoot exercise during proper seasons adds greatly to the 
country boy's enjoyment. Tramping through muddy places, 
when the soft mud will squeeze up between the toes, over 
the wet grass, up and down the shallow streams, climbing 
trees, speeding stick-horses on dirt roads, and chasing butter- 
flies through the clover fields are unknown pleasures to the 
foot-geared boy, not less enjoyable than riding bareback a 
sweating horse to water. But when bedtime came the old 
colored mammy came around with tub and water, soap and 
brush, and rubbed and scrubbed sore toes and bruised heels 
all alike, until the victim's anger aroused the grumpy old 
" granny" to a sense of her cruelty. 

In those days the early life of the country boy on the 
farm was more widely different than now from boy-life in 
town. It was coarser and more rugged, less diversified, but 
freer from dissipations, more limited in companionship, with 
fewer individual resources, and totally unaccustomed to the 
minor vices of a higher and more luxurious civilization. 
The country boy was more self-reliant within the sphere of 
his mental and physical opportunities, but less suggestive of 
side-issues and by-way diversions ; consequently, his life was 
more monotonous, but sufficiently entertaining for healthy 
growth and development. His more regular habits, longer 
hours of sleep, fewer perturbating influences, more active 
exercise in the open and purer atmosphere, freedom from 
society and social excesses, and more enlarged physical effort 
in the ways of natural life, and, as a rule, later and less 
strained mental discipline, all contributed to a more hardy 
and robust physique, and though a slower, certaiuly a more 
uniform development of those qualities of mind which direct 
and dominate the activities of manhood-life. His sports 
were neither scientific nor trained, and his fuu and pleasures 
were the outbursts of natural impulses incited by nature's 



SKETCH OF EARLY LIFE. 59 

environments. He was more natural and less exotic. Habits, 
mode, and incitements of life formulated his judgment, and 
his conclusions and opinions were more intuitive than logical. 

With the beginning of country school-days, and later 
boarding-school conditions, rivalries, and more congenial 
and intelligent companionship, with broader opportunities, 
soon marked the lines of division into two classes : one 
characterized by sloth and lack of force, the other by energy 
and rapid advancement in mental as in aesthetic acquirements. 
As a rule, the boy trained to parental obedience and in good 
morals won the honors of class competition. Brilliant pre- 
cocity was very rare. Parents did not seek adoration in 
such illuminated pictures of overstrained brain faculties, 
with premature maximum mind evolution, abruptly succeeded 
by stupid sloth long drawn out. 

My school-days began at about nine years of age, and my 
wild and child-life ceased, except on Saturdays and during 
brief holidays, consisting of several weeks during dog-days, 
several days at Christmas, two at Easter, one at Whitsun- 
tide, and the 4th of July. There were no legal holidays 
nor thanksgiving days. We were always giving thanks, 
and did not limit them to one day with a feast of mince-pie 
and chicken fixings. I had been taught to read, write, and 
cipher, and took hold of my new work with great avidity 
and ambition. The school began at 9 o'clock a.m., and was 
dismissed at 4 p.m., with an intermission for recreation and 
luncheon of one hour at high noon. For the first year or 
more I rode to and fro on horseback, with the old slave 
coachman behind me, who carried my books, luncheon, and 
marbles. The time consumed on the road and in studying 
tasks at home did not leave much " play-time/' but whatever 
was left before supper and night-study was passed in some 
one of the varying pastimes that came readiest to my relief, 
during which I would often crowd in a whole day of joy 
and active pleasure. The half of many Saturdays was 
occupied with riding to mill on a bag of corn and back on a 



60 A SOUVENIR. 

bag of meal, or in going on horseback to town, nine miles 
distant, on errands and for the mail. The latter was an 
objectless task, more irksome than salutary ; but the former 
afforded an opportunity for a raid on somebody's cherry- 
tree, a swim in the mill-pond, a game at marbles, an occa- 
sional brawl at a country cur dog fight, and, less often, a 
furtive look at a cock-fight with steel gaffs, of which I did 
not make mention at home. On the whole, my mill-boy 
task was not unwillingly performed. A ride for several 
miles and back, up and down hill, on a three-bushel bag 
balanced across a horse's back, was an accomplishment not 
easily acquired by every country boy, and the country grist- 
mill was a place of such genial neighborhood resort and chat 
that a boy could hear and find much of interest, of good and 
evil import, preparatory for the next day Sunday-school. 

On my return from one of those errands to Georgetown, I 
was overtaken by Mr. Nathan Loughborough, then residing 
at Grassland, who introduced himself to me, and inquired 
if I was a son of John Busey, and when informed that I 
was, added that he thought he recognized the horse, old Gin, 
I was riding at the time. As we rode along together chat- 
ting, he told me of his intimacy with my father and said 
many pleasant things of him. When we reached the en- 
trance-gate to Milton, his farm on the river road, located 
about two miles north of Teunallytown, he stopped and 
said that he wished to offer me, in memory of his admiration 
for my father, a colt sired by his favorite stud, the Ace of 
Diamonds, which I accepted with the delight which can only 
be appreciated by a country boy. After parting I rode along 
hastily home that I might tell my mother of my good for- 
tune, who made me acknowledge in her name the generous 
gift. Soon after I was in possession of the colt and later on 
of a riding horse in my own right. This was a most inter- 
esting incident in the history of a boy, in that it enabled a 
gentleman, through his recollection of the horse, to establish 
with the son of his deceased friend and companion the 



SKETCH OF EARLY LIFE. 61 

friendly relations that had, during years before, existed be- 
tween himself and the father." Mr. Loughborough was a 
large, portly, and very handsome man. After his marriage 
with Mrs. Thomas, he took up his residence at Milton, and 
the pleasant acquaintance of the two families was resumed. 

The mixed school of boys and girls brought me into new 
and closer associations with the latter sex, which, I am quite 
sure, exercised a very happy influence in restraining the 
excesses and minor vices to which boys are so prone. I have 
not forgotten the rivalry between a pretty winsome red- 
haired girl and myself for head-place in certain classes, which 
taxed my capacity to the uttermost, and made the competitive 
struggle one of general comment and suggestive innuendo. 
Sometimes one of us would deliberately go from the head to 
the foot of the class, that he might show how easily he could 
reach the second place, and eagerly watch for the mistake 
that would put him or her at the head again ; but our rival- 
ries never grew beyond a lasting friendship, w T hich terminated 
with her death some years ago. My country school-life con- 
tinued during four years with uninterrupted progress, closing 
in a private selected school within easy walking distance of 
the homestead, under the mastership of quaint old George 
Taylor, where, for the first time at school, I met the girl of 
my choice, with whom was formed that unbroken mutual 
affection which culminated in forty-two years of happy 
wedded life. 

The annual three weeks' school holidays, during dog-days, 
was an enforced concession, only granted by the schoolmaster 
when overpowered by the combined effort of the boys and 
girls. After failing in personal applications, begging solici- 
tations, and written petitions to placate his obdurate inhu- 
manity, which was not so much the result of his love of 
conscientious duty, as for the three weeks' rebate in tuition 
fees, the pupils engaged in an intrigue to lock him out, and 
when the day had come for its execution they assembled in 
the school-room, each one armed with some weapon of savage 



62 A SOUVENIR. 

warfare — a broom, sticks, bundles of twigs, bucket of water, 
bags of fine dust, pop guns, bean-shooters, ink-squirts, slates 
and books, and such other pestering missiles as their inge- 
nuity and taste might improvise, securely barred the doors 
and windows with boards safely nailed to the frames, stationed 
guards at every crevice and peep-hole with squirts, dust- 
blowers, or pop -guns, as in their wisdom the committee of 
safety might choose, and then, when all was ready, engaged 
in singing a noisy romping song of triumph and defiance. 
All this was done during the absence of the master at luncheon 
at some near farm-house. The pickets along his route of 
return signalled his approach, and those round and near the 
fortress kept the garrison fully informed of his doings, and 
warned him of the danger of peeping through the cracks or 
banging at the barred openings. The siege was a period of 
grave concern to the imprisoned garrison, lest by " hook or 
by crook" the surly pedagogue should gain entrance and 
force a fight, hot with fright and hul-la-bal-loo ; but his 
impecuniosity always compromised with valor, and he pleaded 
for shorter vacation and less loss of pay, which the committee 
sometimes unwisely conceded, and thus the lockout would be 
happily ended, and the boys and girls, with song and merry- 
making, would hasten home to romp and play through long 
days of delicious pleasure. 

The system of public or common schools had not then 
been transplanted into Maryland soil. The pride of ancestry 
and nativity did not tolerate the intrusion of such Yankee 
notions. The country pedagogue was usually a college 
graduate, more learned than frugal, who had strolled from 
place to place, stopping only long enough at any one place to 
earn a precarious livelihood, and then, with a new suit of 
store clothes and his last tuition fees, take again to the road 
in search of some new field to flog blockhead and truant 
boys and transfuse simple girls with good learning. 

There were several other boys living at equal distance from 
the school-house, who, by arrangement, agreed to meet at the 



SKETCH OF EARLY LIFE. 63 

entrance-gate of an orchard farm, and there discharge our 
horses and foot-boys, to meet us again in the afternoon at the 
same gate for exit, that we might tramp to and fro along the 
roads and pathways through the orchard and under the trees 
laden with luscious fruits in such variety that even such good 
boys could not resist the temptation to pluck them, even at 
the risk of being caught by the old wizen wizard, who, with 
cudgel in her brawny hands, stood guard from " early morn 
till dewy eve ;" but three boys, with stealth intent and fleet of 
foot, were not easily caught or frightened by the enchanter's 
wand. 

In those days the country school-boy did not carry in his 
lunch basket or satchel fruit from home, however abundant 
on the farm, because it bruised and flavored his bread and 
butter, fried chicken, and long sweetening, nor was it half so 
good as that gathered along the way from the hanging boughs 
of well-kept orchard trees. The ways through orchard-fields, 
though longer than the country cross-road, were planted with 
such strong temptations that distance added enchantment to 
the fascination. 

Of the many episodes none gave me more pleasure than 
the conventional visits with my mother in early spring and 
autumn to Georgetown to buy summer and winter clothes for 
special wearing on dress occasions. After an early and hasty 
breakfast, we would enter the family carriage, hung on 
C-springs, by climbing up the unfolded steps. Old Frank 
sat on the front seat in propria persona, with high silk hat, 
brass-buttoned dress coat, and whip in hand, and with old 
horse Snap we jogged away and along the road, with narrow 
ways, marshy places, up rough ascents, and down steep hills, 
here and there jolting over huge boulders, and altogether 
along just such a country road as made a country boy tired 
and hungry at both ends of the long journey of nine miles. 
After purchase of material, with colors of my selection and 
quality to my mother's liking, off to old Tailor Cammack 
to have patterns made by which to cut trousers and round- 



64 A SOUVENIR. 

abouts for the domestic seamstress to fit and make, and then y 
after luncheon on cheese and crackers or candy and horse- 
cakes, jog back again to home, in high glee and brimful 
of brag about my new clothes, ribbon cravats, and bosom 
shams. With wistful pleasure, I watched day in and day 
out, and all day long the needle and thread as the seams 
grew longer and the pieces grew into shapely clothes, and 
wished for rainy days, that outside chores might not call the 
sewing-girl from her work. And, when all was done, I 
waited for the coming Sunday to don my suit of newly made 
clothes and show myself to all the people of the neighbor- 
hood. My first tailor-made suit came late in boyhood life, 
and was wonderful to behold. 

I cannot fix the date of the earliest of those semi-annual 
visits to Georgetown, but the vivid recollection of an inci- 
dent that occurred in 1835 enables me to state that such 
visits must have begun about or perhaps a year previous to 
that date. The roughest part of the long journey was over 
the cobble-stone pavement on High, now Thirty-second 
Street, which began at its intersection with Market, now 
Thirty-third Street. At that date High, Bridge (now M), 
and Water (now K) Streets, and several others between M 
and K Streets were partially paved with cobble-stones, vary- 
ing in size from two and three to twenty inches in diameter. 
The surface of such streets was so uneven that no two 
wheels of a moving vehicle were ever on the same level at 
the same time — so that our carriage got a four-cornered jolt 
with every turn of its wheels, with now and then a scrape 
down the slippery surface of a huge boulder into a sharp 
angular crevice, followed by an upward jog over the rugged 
face of another in like displacement. The acute angular 
gutters at street-crossings were also in evidence of the crude 
method of street-paving in vogue at that early period. But, 
notwithstanding such rough usage of the carriage, the coun- 
try boy was too much entertained with the strange and 
changing sights on the busy streets to heed the discomforts 



SKETCH OF EARLY LIFE. 65 

incident thereto. Hogs and cows ran at large in the streets. 
Hogs were municipal scavengers and could only be driven 
from their wallow in the filthy streets by the rough thumb 
of the horse's hoof or the sharp contact of the tire of a wheel. 
It was not unusual to see a litter of hungry, squealing pigs 
following the mother sow in search of house slops thrown 
into the streets, or a herd of milch cows chasing a load of 
hay, straw, or fodder to steal a bite of much-needed pro- 
vender. 

On market days Bridge and High Streets were more or 
less crowded with wagons laden with farm products. Some 
were drawn by oxen, and others by two, four, or six horses. 
Many of the latter were decorated with hame-bells, jingling 
out of tune and filling the air with such " tintinnabulum of 
rhyme " that made the boys whistle in responsive discord 
and pat juba on the sidewalks. There was another quite 
numerous class of vehicles, known as trading or huckster 
wagons, that made weekly or semi-weekly trips through the 
neighboring counties of the adjacent States, trading with the 
people in butter, eggs, poultry, fresh and dried fruits, and 
giving in exchange such articles of merchandise as the coun- 
try people might need or barter for. Those great moving 
shops were strongly built with huge board bodies, roofed 
with canvas. On the sides were hung tiers of slat baskets, 
crates, and locked boxes for the better conveyance of such 
products of the dairy and farmyards as could not be safely 
packed in the inside ; and always in his place, under the 
front axle, the mastiff was on guard watching shoplifters 
and other intruders. He carried the danger sign in his glar- 
ing eyes and sullen visage. The sidewalks were more or less 
crowded with people of all ages and conditions of life, some 
loafiug in busy idleness, others occupied in business and trad- 
ing pursuits, many in objectless haste to reach some other 
locality, and others simply to see and be seen. The town 
and country people, as usual, were easily distinguished by 
dress, manner, and style of carriage. 

5 



66 A SOUVENIR. 

The visits to town were abrupt breaks in the life-history 
of a country boy, and brought into sharp and impressive 
contrast the differences between the routine of pleasure with- 
out care and the activities of town and trading pursuits. 
The novel and varying sights were interesting and profit- 
able, and added much useful information to his knowledge 
of human nature. 

About this period two circumstances occurred : the first, 
perhaps, a year earlier than my first semi-annual visit to 
Georgetown. My recollection is that I was six years old, 
which would fix the date of July, 1834. It was my first 
visit away from home in company with my mother on a 
visit to her brother, Thomas Clagett, at Weston. While 
there I was taken sick with chicken-pox and my mother 
hurried home with me. My recollection is that it was a very 
fatiguing journey on a warm day. I must have been sicker 
than children usually are with that disease, because I have 
numerous marks upon my person, which have always been 
ascribed to it, but I have no recollection of any suffering. 

The other circumstance relates to a second visit away from 
home in company with my cousin, Ellen Snowden, who was 
one of the three heirs of the estate of our greatuncle, Samuel 
Busey, to which I have previously referred. It was a visit 
to Count Charles Julius de Menou, who was an intimate 
friend of my father, and after his death an occasional visitor 
to the homestead. 

I rode behind my cousin, who was accompanied by Dr. 
James Wallace. The route was from the homestead along 
the river road through Tennallytown to the road, now known 
as the Pierce Mill road, along which we passed the Adlum 
vineyard, the old dwelling of Abner Pierce, the mill, across 
Rock Creek, and thence by the race-course, located about the 
village of Mt. Pleasant, by a road to a farm east of Seventh 
Street road, where the Count was then residing. I cannot 
locate the farm. There is no record of his ownership of any 
property in the county of Washington outside of the limits 



SKETCH OF EARLY LIFE. 67 

of the city. It may have been a temporary summer resi- 
dence. After remaining there about a week we returned to 
the homestead in the same manner as we had made our ex- 
cursion there. The Count was at one time quite a large 
holder of real estate in this city, having held at one time 
the property on H Street, JST. W., formerly known as the 
"chain building/' and now occupied in part by the Epiphany 
Church Home. My visit to him with my cousin and his 
visits to the homestead do not recall any incident of special 
interest beyond the pleasant memory of a very courteous and 
attractive gentleman, who made himself very agreeable to 
small boys. These circumstances, like others I have nar- 
rated, illustrate the lasting impression made upon the mem- 
ory by the intercurrent events of early life. The fact of 
riding on horseback behind another was not a novelty, nor 
did the way add interest to the journey until it reached the 
intersecting road along which the places passed were new 
and previously unknown to me, but made so interesting to 
me by the description of our genial escort and companion, 
that I have retained a keen recollection of those incidents of 
the journey. The farm-house was an old-fashioned one- 
story wooden building, with a gable roof and long piazza in 
front, looking out upon a neatly kept lawn. The Count 
was a cordial and generous host. He was very bald, and 
wore a wig, which he frequently removed and put into his 
hat. 

At a later date I made another visit to Georgetown to 
witness a Fourth-of-July Sunday-school celebration. It was 
the custom then, and for many years afterward, for the Sun- 
day-schools of the Protestant congregations to unite in cele- 
brating the Fourth of July. After weeks of preparation 
the schools assembled at an early hour at some one of the 
churches and marched thence in column of four abreast, 
with banners, music, and other suitable patriotic parapher- 
nalia, to Parrot's woods, where a stand had been erected and 
decorated with flags and flowers. The grand marshal, with 



68 A SOUVENIR. 

his adjutants and aids all on foot, conducted the procession 
in an orderly manner through certain streets, previously 
designated, along which on the sidewalks would gather the 
parents and friends of the children to cheer them with 
waving flags, banners, and handkerchiefs, and join in the 
patriotic hurrah. The whole population turned out to wit- 
ness the pageant, sing praises of joy, and to salute the star- 
spangled banner. After assembling at the woods under the 
old oak trees, an invocation was offered by some one of the 
clergymen, then the Declaration of Independence was read 
by some one previously selected for the purpose, followed by 
an oration, which concluded the exercises. On this occasion 
the oration was delivered by George Washington Parke Custis, 
of Arlington. He was an awkward but enthusiastic speaker. 
His whole body seemed to respond to his utterances, which 
were delivered with vehemence and fervor. After the con- 
clusion of the joint celebration the children dispersed at 
pleasure, and the afternoon was passed in such gala amuse- 
ments as were most congenial. 

Other episodes, not less interesting, but very different in 
entertainment, have left upon the memory an impress quite 
as lasting and vivid. My half-brother was a Whig, and a 
very enthusiastic and active supporter of William Henry 
Harrison for the Presidency. He attended all the cross-road 
meetings and l ' hard cider " barbecues during the campaign, 
occasionally taking me with him, once to Rockville, and at 
another time to Bladensburg, where I joined in the "hip, 
hip, hurrah " for "Old Tip and Tyler, too." 

The barbecue at Bladensburg took place on the 4th of 
July. There were many speakers, but I recall the name of 
but one, Walter Lenox, late mayor of this city, who greeted 
the audience with the salutation, " My fellow-countrymen." 
This was so different from the usual address of political or 
stump speakers that it attracted my attention, and led to the 
inquiry, which was answered by the statement that he was 
not a resident of Maryland, but of the District of Columbia. 



SKETCH OF EARLY LIFE. 69 

The barbecue at Pockville occurred later during the cam- 
paign, perhaps during the holiday season of the academy, 
because it was held within the inclosure of that institution. 
It was a much larger and more enthusiastic assemblage, in- 
cluding many ladies. Two log cabins had been erected, in 
which numerous barrels of cider had been placed, from 
which the beverage was dispensed in glasses and mugs, 
through open windows, to every person in such number of 
glasses as each might choose to ask. The supply seemed to 
be inexhaustible, and was drank ad libitum. Toward the 
close of the day the enthusiasm became very pronounced 
and boisterous, to which the glee club, with its campaign 
melodies, added an entertaining merriment. On this occa- 
sion I heard, for the first time, the late Eeverdy Johnson 
and Joseph H. Bradley, Sr. The latter I had known pre- 
viously, and was especially impressed by his description of 
the late Francis P. Blair, whom he characterized as the 
ugliest man on the face of the globe. 

Some time during the same campaign I attended a Har- 
rison and Tyler meeting at Georgetown. It was held in 
Parrot's Woods, now the Oak Hill Cemetery. Governor 
Call, of Florida, was the leading orator on that occasion, 
and impressed me as a very handsome man and a fluent and 
graceful speaker. He had lost an arm — I think the left — 
the stump of which he would touch with his right forefinger 
whenever he sought to make a very impressive gesture. My 
recollections of these events seem to be indissolubly asso- 
ciated with the apparently trivial incidents relating to the 
salutation of Lenox, the ugliness of Blair, and the gesture 
of Call. 

As the day for the inauguration approached my brother quite 
often asserted his intention to attend, and finally, after much 
begging on my part, consented to allow me to accompany 
him to witness the imposing ceremonies, March, 1841. On 
the morning of that day we made an early start, I riding by 
his side on old Gin to Georgetown, and then walking along 



70 A SOUVENIR. 

Pennsylvania Avenue, watching with gaze and astonishment 
the President on horseback, with bared head, and the great 
procession of men, soldiers, carriages, and platform-wagons 
laden with machines, to the east front of the Capitol, where 
I heard the inaugural address and saw the President of the 
United States take the oath of office. Then back to the 
White House with the dense crowd on the street, and 
" piggy-back " through the denser crowd at the Executive 
Mansion to shake hands with President Harrison. It was 
my first sight of a great procession of soldiers with dazzling 
uniforms, glittering sabres, burnished guns and waving 
plumes, some on horseback, many on foot, and others riding 
gun-carriages and caissons, with men decked with badges, 
ribbons, and streaming sashes, bearing banners, flags, and 
ludicrous caricatures, followed by a long train of vehicles, 
and many wagons with four and six horses dragging indus- 
trial machines, some in operation turning out the manufac- 
tured articles, which were thrown to the gaping and bellowing 
crowd pressing close to the beasts and under the wheels. All 
this, with drum and fife, bands of music with great shining 
brass instruments, and " glee clubs '' singing " Tip and Tyler 
too" and "hard cider" melodies, and others roaring out the 
partisan slogan, " Roast beef and two dollars a day," such 
as a country boy never saw or heard before. What would 
life at sixty-eight be without such a recollection ? I have 
seen many similar processions since, but none seems to have 
been as large, none so brilliant and impressive. Thrilled 
with wonderment, filled with the vastness of things all new 
to me, and amazed at sights never before heard spoken of, 
I tramped back to old Gin and the saddle, and rode along 
the lonely road home in profound silence, but with that 
pride and satisfaction that seemed to lift me far above the 
level of the crude and awkward rural champion. 

Not long afterward I came again to the city, but then to 
see a procession with flags furled and banners draped in 
mourning, marching in solemn slowness to the funeral dirge, 



SKETCH OF EARLY LIFE. 71 

in sorrow for the chieftain whom a few weeks before I had 
seen ride in triumph to the Capitol. 

And again, a year later, in company with Richard Williams, 
a near neighbor and friend of my mother, I came to see Con- 
gress in session, and for the first time to look down from 
the galleries upon the assembled wisdom of the Nation, of 
which I had heard so much. I saw members, some in loose 
blouses, others in trig attire, walking all about in noisy 
familiarity. I watched the Speaker's gavel calling to order, 
and men all about the hall jumping up and calling out to 
catch the Speaker's eye, and saw the pages chasing the loud 
calls and sharp raps of impatient members. The clerk 
would read a few words, and then again from all parts of 
the echoing hall would come the emphasized and redupli- 
cated resounding call — " Mr. Speaker," as if every man was 
full of fight and only waiting for some one to knock the 
chip off his shoulder. It was so different from the solemn 
church services, where one man did all the talking, to which 
I had become accustomed, that I was not anxious to come 
again soon. In the Senate chamber I felt as if I had been 
suddenly transported back to Bethesda and was in the sol- 
emn presence of old Dr. John Mines, listening to some 
awful story of hell-fire and hot-lead poisoning; but imagine 
my awe when I was ushered on tip-toe into the gloomy vault, 
under the present chamber, of the Supreme Court and beheld 
the old gray-haired and bald-headed judges robed in gowns 
as black as first-class mourning dresses. I stored away lots of 
experience and history during that one day, and grew so 
bold and proud with imitative eloquence that Buddy Gus 
felt it to be his duty to check the progress of my parlia- 
mentary aspirations by such ridicule and mimicry as his ready 
w T it might offer. 

Dancing was no part of my early education. Presby- 
terianism and Methodism were too rife among the goodly 
people to tolerate such giddy but rhythmic grace of move- 
ment and joy of youth and maiden. My mother was not 



72 A SOUVENIR. 

averse to it, but the neighborhood proprieties would have 
been shocked at such assemblages of boys and girls. On one 
occasion I was permitted to accompany my half-brother to a 
large wedding, and there for the first and only time during 
boyhood life saw ladies and gentlemen engaged in dancing. 
I believe the neighborhood restraint was somewhat relaxed 
after I left the country, in 1845, and the young people did 
occasionally steal an opportunity and dance in defiance of 
the censorship of the matrons and more austere spinsters who 
had never enjoyed the fascinating pleasure. In fact, except 
on the occasion referred to, I never saw any dancing until I 
came to this city to live, in 1848. 

The reader will, therefore, not be surprised that my re- 
sources of pleasure and pastime were limited to the intuitive 
devices and inclinations of farm life and to the primitive 
habits and customs of a country neighborhood and exclu- 
sively rural society. But, notwithstanding the absence of 
and aversion to some of the gayeties common to most coun- 
try neighborhoods, even in those days, the routine of life was 
sufficiently diversified to be very attractive, especially so to 
the boy who was free to indulge his fancies and inclinations 
and could command at will the assistance of and direct others 
in subordination to his own proposals. 

With the beginning of the autumn session (1841) of the 
Rockville Academy I bade farewell to those joys, deviltries, 
and pastimes that had greeted the younger life with so much 
pleasure ; and there began, with other companions and fresh 
rivalries, the struggle with the problems of a higher curric- 
ulum, where gratification came only through the higher 
marks of success and proficiency. The study-room was the 
only playground, and the class recitation the only field sport. 
Perhaps I can better tell the story of my life at the Academy 
by narration of the following events : Joseph H. Braddock, 
a man of great learning and principal of the classical de- 
partment, died early in September, 1843, and the students 
in that department were left without a teacher until his 



SKETCH OF EARLY LIFE. 73 

successor, Otis C. Wight, now of this city, was elected late 
in November. Immediately after the death of the principal 
the students remaining in the village, nine in number, or- 
ganized into a class and elected the senior, William S. Graff, 
to the tutorship, to whom all recitations were made as regu- 
larly and promptly as to the deceased principal. The Board 
of Trustees of the Academy at that time was constituted, 
with others, of John Mines, D.D., a distinguished divine of 
the Presbyterian denomination ; E. Erving Gillis, D.D., 
afterward rector of Ascension Parish in this city ; Richard 
John Bowie, late Chief Justice of the Court of Appeals of 
Maryland, and John Brewer, a distinguished attorney at 
the local bar. All the applicants for the vacancy failed at 
the first examination, and the advertisment for applications 
was renewed. A day or two afterward Mr. Wight reached 
the village, and, being informed of the failure to fill the 
vacancy, determined to wait until the second examination. 
In the meantime, by request, he assumed the tutorship of 
the class of nine, and on the day of examination of appli- 
cants that class of boys voluntarily united in a petition to 
the Board of Trustees in favor of the election of Mr. Otis 
C. Wight to the vacancy. I do not know how much, if any, 
the recommendation influenced the Board, but he was, to our 
great satisfaction, selected. I may be excused for concluding 
this narrative with the following letter from this venerable 
aud honored man : 

306 Indiana Avenue, October 14, 1895. 
"Dear Dr. Busey: 

" I have received, through the hands of John, a copy of your Per- 
sonal Reminiscences, for which please accept my thanks. I have 
already been much interested in some portions of the book, and am 
anticipating pleasure in further perusal. But I am especially grati- 
fied in being thus remembered by one of the first pupils at the 
Rockville Academy — one of the nine in the classical department. I 
often think of those days, just fifty-two years ago. I had been out of 
college one year and had launched my boat on the sea of life, almost 
as uncertain where I should cast anchor as the patriarch Abraham 



74 A SOUVENIR. 

was when he left home. I am a firm believer in the leading and 
guiding hand of my Heavenly Father, and I thank him for leading 
me to Eockville, a place which I knew not of ten or twelve days be- 
fore I commenced teaching the ' nine.' I have kept them all in 
interested remembrance and watched their progress. I sincerely 
congratulate you for what you have accomplished, for the distinction 
you have achieved, not only in practice professional, but for your 
numerous contributions to medical literature. 

" Most truly your friend, 

"0. C. Wight." 

During my residence at Eockville I lived with one of two 
private families — during the first year with the family of 
Thomas F. Vinson, and afterward with that of John Brewer. 
My mother was averse to boarding-house life, where I could 
have had the companionship of school friends and class- 
mates during out-of-school hours. My pleasures and pas- 
times were, therefore, limited and mainly restricted to my 
own resources, which consisted for the most part in study 
and reading, with an occasional ramble, most often alone, 
but sometimes with some chum with whom I had made a 
special engagement to go swimming, fruit-hunting, nut- 
gathering, or for some other mutually agreeable recreation. 
On one occasion, made memorable by certain incidents, I 
occupied the greater part of an off-day in gathering chest- 
nuts for my winter supply. After strolling for some time 
through unknown forests and fields, I discovered in an open 
field a very large chestnut tree with wide-spreading branches 
filled with open hulls ready for the thrashing-pole. I 
climbed to its upper branches, and as I descended thrashed 
every branch until I thought I had stripped it of every ripe 
nut ; then gathered them into my bag, and trudged back 
home with the product of my half day's hard work, for 
which I was complimented by Mr. and Mrs. Brewer. A 
few days after one of two maiden ladies, who was notorious 
for her boisterous dislike of mischievous boys, dined with 
the family, and while at the table opened fire with volley 
after volley of just such words as made me wince in silent 



SKETCH OF EARLY LIFE. 75 

and mute desperation, lest I might in some manner exhibit 
some sign of guilt that would provoke her anger beyond the 
vehement utterance of cuss words. Mr. and Mrs. B. very 
soon connected me with the offence, and very adroitly as- 
sisted me in escaping detection. Miss Belle never discovered 
the offender, and I never again invaded her premises. 

As a matter of personal history another incident may be 
worthy of record. Attracted by the apparent pleasure and 
consolation which the village smokers, as they loafed about 
the streets, seemed to derive, I reasoned myself into the 
belief that I might find company and comfort in the vice. 
On a single occasion, on my way along the street to my 
home on the outskirts of the village, I bought at a grocery 
store a cigar of the Principe brand, put it safely into my 
pocket, and walked along leisurely homeward in lonely con- 
templation of the pleasure to come. Late in the afternoon, 
after I had completed my study task, I strolled into the 
peach orchard to gratify a gluttonous appetite with the 
ripened fruit, and when fully satisfied sat down on the grass 
under a tree in peaceful contentment, lighted my cigar and 
puffed away great mouthsful of smoke that curled upward 
through the leaves of the overhanging branches of the tree. 
Every boy with such early experience knows full well what 
followed. The half-consumed cigar soon dropped from the 
finger's grasp, my head began to whirl, sight grew dim and 
dimmer, with visions of indescribable forms floating near and 
far in the circumambient space, like spectres in " confusion 
worse confounded," languor was followed by such relaxation 
that I lay so prostrate upon the greensward that I could not 
roll from side to side in the agony that came with the mouth 
gaping so wide that the joints of my lower jaws would creak 
with strain, the tongue would protrude with such force 
against the lower incisors as seemed would cut it crosswise, 
and the upheaving straining of a stomach filled to repletion 
added torture to the anguish of my suffering. I need hardly 
add that I was late at supper and early to bed that evening. 



76 A SOUVENIR. 

Several decades passed before I again tested the flavor of a 
Principe, but now I am not unlike the village loafer, seeking 
pleasure and consolation in the vice of smoking. 

With such exceptions my life at Rockville was uneventful, 
with a weekly visit home, which for the most part was passed 
in idle recreation with the family, and a visit to Springfield, 
the homestead of the Posey family, to keep up and foster 
my acquaintance with the girl to whom I have before re- 
ferred, until she, like myself, was sent away to boarding- 
school, the circumstance which, perhaps, had more influence 
than any incident of my life in determining my course of 
conduct in after-life. I lived then to win her love, as I lived 
long afterward to make her happy and comfortable. There 
were pretty girls at Kockville, but I was callous to their be- 
witching charms, "for never was one more blind to beauty 
that hangs upon the cheeks." 

My sly visits on Saturdays to Springfield were not always 
free from perturbating incidents that sharpened the ragged 
edges of disappointment and pierced my hopes with discon- 
solate misgivings. Miss Catharine had younger sisters, 
especially one just at the age when little sisters w 7 ill hang 
around, catch bits of conversation, and take pleasure in tell- 
ing tales out of school. I was not afraid of her gossipy and 
tattling tongue, for I was too shy and timid to tell the story 
of my love, and kept as far away from the real object of my 
visits as a bashful youth tries, but usually fails, to do. The 
fascinations of a pretty girl, with winsome ways and not 
altogether free from coquettish pranks, are a little too much 
for the country youth whose bashfulness is the measure of 
his infatuation. On such occasions the little sister, with coy 
reluctance, would whisper, in sentences broken by pert side 
glances and smothered exaltation, into my wistful ears stories 
of the frequent visits of rival suitors, whose opportunities 
were so much more favorable than mine, that sank so deep 
into my heart as sometimes to hasten the good-bye and a 
petulant departure, to return along the lonely road to Stony 



SKETCH OF EARLY LIFE. 77 

Lonesome, and there to drain the cup of pout and heavy- 
heartedness in mock merriment and improvised good cheer. 
But, with fresh courage, the succeeding Saturday found me 
on the road to repeat my visit, and the greeting of the little 
sister, perhaps at the entrance gate, where she was wont to 
watch, with the welcome salutation that sister Kitty was 
waiting my arrival, was sufficiently significant to inspire 
even such a diffident lover with hope, and 4 encourage him to 
accept the innocent pranks of a girl's affection with less 
trepidation. 

I do not know how much the chatty sister may have teased 
my rivals with newsy tales of myself, for they were older 
than I, and looked upon me as a lovesick youth whose 
infatuation would attenuate with delay ; but she was my 
good friend, and seemed to play the part of an avaunt- 
courier, bearing peace-offerings, with bits of information that 
served, at least, to lighten the burden of distrust and hold 
out a ray of hope. Like one drowning, I caught at every 
straw, and drank in deeply the friendly prattle. I was even 
more ready to accept trivial signs of favor than quick to 
pout with the dumps. And so the boyhood courtship ran its 
course of miseries and pleasures through several weary years, 
with gradually increasing confidence, before I could screw my 
courage up to the sticking-point "to tell the story of my timid 
homage," and bear away " the chief of all love's joys" — " the 
breath of a maiden's yes." 

This event came to pass during the early autumn of 1845, 
after I had commenced the study of medicine in the office of 
Doctor Hazekiah Magruder, in Georgetown, and the young 
lady had finished her course of studies at the seminary in the 
same city, kept by Miss English, and each of us was freed 
from the discipline of boarding-schools, which had limited 
our interviews to Saturdays. I was then at liberty to make 
my visits at my pleasure and her convenience. Previously 
I had chosen Saturday because both of us were at our country 
homes on that day, and I was not so likely to be embarrassed 



78 A SOVVENIB. 

by the intrusion of other visitors. During the succeeding six 
or eight months our affianced lives ran their course in smooth- 
ness until broken by my departure for Philadelphia to enter 
the private office of Prof. George B. Wood, and to matricu- 
late in the University of Pennsylvania, from which I grad- 
uated on April 8, 1848. During my residence in Philadelphia 
I made but one visit home, during which I was a daily visitor 
at Springfield. The photogravure picture marked 1848 is a 
reproduction of a daguerrotype taken a few days before my 
graduation. 

In those days engaged people did not rush into the public 
press to announce it. The engagement was held as an invio- 
lable secret, not to be communicated outside of the immediate 
families of the affianced couple until the wedding-day was 
fixed. Of course, in a country neighborhood, gossipy innu- 
endo and suggestion kept up a continuous discussion of an 
affair which everybody believed, but no one knew to be 
true. Immediately after graduation in medicine I settled 
in this city, and was married on the first day of May, 
1849. 

As I have, in the foregoing pages, referred to the slave 
environments of my early life, it may not be inappropriate 
to supplement those allusions with some more general state- 
ment of such surroundings as I saw them at that early date. 
Whilst the general and enforced manumission of slaves must 
have convinced every reflecting person of the evils of slavery 
in general, and more especially of the adverse influences of 
slave-labor, so obstructive to the progress of a higher civili- 
zation, my young experience leaves no impression of those 
wrongs and cruelties of which I have heard and read so 
much in later years. There were not many slaves in the 
neighborhood, but nearly every farm was cultivated in whole 
or in part by slaves, in some cases led in the field by the 
owner or grown sons, with hired white labor, between whom 
and the slaves there were no labor distinctions. In the harvest 
and mowing fields the best cradler and most expert scythe- 



SKETCH OF EARLY LIFE. 79 

man, white or black, would be awarded the leadership, and 
the las^ard fell to the rear. 

They were, with rare exceptions, an orderly, quiet, well- 
behaved, church-going people, usually attending the master's 
church. All had their go-to-meeting clothes, the women 
with red or striped turbans, a neat, if not tasteful, head- 
gear, and other dress- wear, if not to match, quite as pleasing 
to their taste. Every slave family had its farm perquisites, 
in the way of allowances for free and over- time, rabbit and 
partridge trapping, nut-gathering, fruit-drying, garden truck, 
and, occasionally, a pig to feed and butcher for barter, and 
small money donations, with off Saturdays to go to town to 
barter and buy. They were cheerful, if not the most indus- 
trious laborers. Negroes, like most white people, love labor 
best with least hard work, and if not frugal in their methods, 
they accomplish their work -tasks without detriment to their 
physical being. Surely my association with and youthful 
observations of the negro slaves during my country and 
farm Jife occasion me no regret. They treated me with 
kindness, gentleness, and, perhaps, too much forbearance, 
and the " mudders" were more ready with rod and switch to 
punish my companion-playmates than those who were better 
judges of my aggressive spirit. I do not claim this picture 
of contentment and happiness was free from blemishes, but 
they were only such as served to bring out the finished parts 
in more vivid contrast and make a more enduring impression. 

To conclude this sketch without a final reference to the 
wife of forty-two years of a happy life would prove me 
recreant to the finer feelings of honor and affection. Not 
one day has passed since her death, January 26, 1891, that I 
have failed to recall the charming recollections of her sweet 
and lovely disposition, and to-day I cherish her memory with 
the same pride and ardor as when the two young hearts were 
made one. To those who knew her no eulogium is necessary 
to revive and intensify their admiration, nor can I offend the 
precious memories of her life by any attempt to picture her 



80 A SOUVENIR. 

pure life by the measure of my affectionate regard and 
devotion ; but I write of her as others knew her. Her 
Christian purity remains to-day untarnished by one thought 
or spoken word of evil of any human being. Her kindly 
and equitable temperament, mellowed and strengthened by 
genuine friendship, high integrity, benevolence, and Christian 
faith added beauty and simplicity to a character so blessed 
with the saintly qualities of mind and heart that none knew 
her but to love her, and the better she was known the more 
she was loved. I forbear to add another word. 



MISCELLANEOUS ESSAYS 



ADDRESSES. 



MEDICAL ASSOCIATION OF THE DISTRICT OF 
COLUMBIA. 

ADDRESS BEFORE THE MEDICAL ASSOCIATION OF THE DIS- 
TRICT OF COLUMBIA, OX A RESOLUTION TO REVISE 
ITS CODE OF ETHICS AND REGULATIONS, 
DELIVERED MAY, 1874. 

In support of his motion Dr. Busey said he had offered 
the resolution believing the time had come when the Asso- 
ciation should be reorganized. Its Code of Ethics and reg- 
ulations should be revised and made to conform to the 
Code of Ethics of the American Medical Association. As 
this body, to qualify its delegates to the national organization, 
was compelled to adopt the Code of Ethics of that body, and 
every delegate presenting his credentials was required to sign 
it, it was manifest that no local provision or regulation antag- 
onistic to the general code could be binding. 

The code of the American Medical Association was liberal 
and surely sufficient to guide and control the intercourse be- 
tween medical gentlemen and between physician and patient. 
All provisions and regulations of the local code inconsistent 
with and antagonistic to it should be stricken out. He pointed 
out several of these contradictions, and he maintained, further, 
that stringent and penal regulations accomplished no good. 
Honorable gentlemen did not need them, and dishonorable 
men did not obey them. Unless penal laws were rigorously 
and impartially enforced the innocent suffered, and experi- 
ence had clearly shown that this body would not sustain the 
standing committee in its efforts to maintain the authority of 



84 ESSA YS AND ADDRESSES. 

its own enactments. Hence he desired the good to be as free 
as the bad. 

He insisted that the Association should disconnect itself 
from the Medical Society of the District of Columbia, and 
not require a license from that organization as an essential 
qualification of membership. 

He claimed that female physicians should be allowed con- 
sultations. While he was not the advocate either of mixed 
medical schools or of female doctors, and thought that medi- 
cine was not the calling of women, still he was not forgetful 
of the fact that in times past women had risen to distinction 
in the profession, and believed there was more than one then 
living destined to become eminent. 

If it was an evil, it was such an evil that neither this 
organization nor the entire medical profession of the country 
could abate, and hence it was the part of wisdom, justice, and 
humanity to strike from their regulations all provisions pro- 
hibiting the members from consulting with female doctors. 

This Association purported to be a voluntary organization, 
but its arbitrary and illiberal regulations made membership 
compulsory, because it denied to regularly educated physicians 
rights and privileges which belonged to them as physicians, 
and required them to seek admission to secure such rights. 
He maintained that consultations were for the benefit of and 
belonged to the patients, and that no local society had a right 
to restrict consultations to its own membership. The regula- 
tion of the American Medical Association governing consulta- 
tions was wise and humane, and nothing more was necessary. 
By denying consultations to those not members and to 
females they punished the sick, denied to them the medical 
advice they desired, controlled members who wished to main- 
tain the integrity of the Association, and by failing to punish 
those who violated its regulations permitted those of question- 
able honor to seek and solicit the patronage of the non-mem- 
bers, to the injury of many members. 

He was opposed to the restriction placed upon professional 



ESSAYS AND ADDRESSES. 85 

intercourse with army and navy surgeons stationed in this 
city and faithfully discharging the duties imposed upon them 
by law. He maintained that it was a gross injustice to re- 
quire them to become members of this organization to obtain 
consultations with the civil faculty, and derogatory to their 
dignity. As the regulations then stood they were required 
to obtain a license from the Medical Society of the District 
of Columbia, and then with that as their essential credential 
to apply for admission to this body, or else those whom they 
might be called upon to attend among the army and navy 
families stationed or residing in this city could not obtain 
the professional advice of a practitioner in civil life in con- 
sultation with such surgeons — a monstrous injustice to the 
members of this Association. 

He was opposed to the admission of medical men employed 
as clerks in the departments, not because they were necessa- 
rily incompetent, as had been asserted, but because from the 
nature of their employment they could not be thoroughly 
identified with the profession. He was willing to concede 
to them every right necessary to qualify them to pursue their 
profession during their leisure hours, but he was unwilling to 
clothe them with authority to regulate the practice of medi- 
cine in this District, to enact penal regulations, to limit and 
prescribe the duties of men whose entire lives, time, and abili- 
ties were exclusively devoted to the practice of medicine. He 
would, therefore, so revise the regulations as to do away with 
the requirements of membership to secure privileges which 
ought not to be denied. Membership should be voluntary. 
It was compulsory as long as it was necessary to secure rights. 

The Association had but two purposes — to maintain a Code 
of Ethics and to establish a schedule of fees — and owed its 
existence to the fact that the charter of the Medical Society 
of the District of Columbia prohibited that organization from 
doing either. It was a clear and palpable evasion of the intent 
and purpose of that law, and always appeared to him to 
have been formed by men who at that time (1833) had all the 



86 ESSAYS AND ADDRESSES. 

practice and were determined to retain it while they lived. 
He did not believe that any young man, however pure and 
honorable he might be. could stand squarely up to the letter 
and spirit of the regulations and ever have a profitable busi- 
ness among the resident population. 

He was willing to concede the probable advantage of some 
few general regulations governing fees — perhaps a minimum 
limit; but he was opposed to the details of a schedule. The 
physician and patron should determine the compensation by 
the character, importance, amount, and appreciation of the 
services rendered. If the man of twenty years' experience or 
the specialist who had devoted his time and talent to the study 
of a particular class of diseases was worth no more than the 
graduate fresh from college, then experience, study, and ob- 
servation went for nothing. The exactions of a fee-bill were 
unjust to a man of experience and to the beginner. In the 
former case too much labor was imposed to realize a compe- 
tent support. He was overtasked with work, and his remu- 
neration was in proportion to the amount of work, without 
proper appreciation of the merit and quality thereof. The 
beginner was required to estimate his services at the same 
value as the skilled and experienced physician, and hence he 
was brought in direct competition with him on a basis of 
compensation. Surely it must be manifest that upon such 
a basis the skilled would reap the rewards, while the unskilled 
would stand idly by. 

He finally expressed his conviction that penal codes failed 
either to maintain or to elevate the dignity and purity of the 
personnel of the profession. If they wished to raise the stand- 
ing of the profession, it must be by individual emulation in 
professional qualification, in dignity, and in honorable and 
manly bearing. He would widen the contrast between merit 
and incompetency, between honor and dishonor, between the 
man of unflinching integrity and the man who by manoeuvres, 
cunning, and unworthy artifice sought to subsidize the con- 
fidence and respect of a community. He would hold the 



ESSAYS AND ADDRESSES. 87 

membership as something distinctive — a line of separation 
between the worthy and unworthy. While membership was 
necessary to secure privileges and rights which properly and 
legally belonged to every regular practitioner of medicine, 
whether worthy or unworthy, the implied obligation rested 
upon theoi to admit every applicant, however low in morality 
or deficient in qualifications. Let the applicant come volun- 
tarily, seeking a badge of honor and distinction, and not be 
driven to them by their arbitrary regulations. 



THE GATHERING, PACKING, TRANSPORTA- 
TION, AND SALE OF FRESH VEGE- 
TABLES AND FRUITS; 

Their Chemical Constitution and Nutritive Value; 

Competent Inspection and Free Markets 

for Producers. 

delivered at the annual meeting of the american 

public health association, in philadelphia, 

november 11, 1874. 

It is not my purpose, at present, to discuss this question 
in all its important relations to the health of cities and of 
communities of consumers, but briefly to invite the attention 
of this Association to a few suggestive inquiries, with the 
view of securing, through a competent committee, a thorough 
consideration of the effects upon public health of the deterio- 
ration of fresh vegetables and fruits, as offered for sale in the 
markets of the principal cities of this country, and how far 
this deterioration is attributable to the manner of gathering, 
mode of packing, and transportation from the farm or garden 
to the city markets. 

No one will maintain that masses of consumers can be 



88 ESSAYS AND ADDRESSES. 

supplied with vegetables and fruits in the same state of fresh- 
ness and perfection as the rural population, for all must admit 
that under the most favorable conditions, with every requisite 
care, many vegetables and fruits rapidly lose freshness, flavor, 
and nutrient qualities. The state of perfect maturity speedily 
passes, and deterioration and decay begin. So, likewise, 
must it be conceded that, as a rule, fresh and mature vege- 
tables, in their proper seasons, contribute to enjoyment and 
health, and in the country rarely provoke disease ; and, fur- 
thermore, I need hardly remind you that, in our American 
cities, the summer intestinal diseases and digestive troubles 
usually begin with the introduction of certain fresh vege- 
tables. Here I shall be met with the objection that the in- 
testinal diseases mostly prevail among very young children, 
who are consumers of vegetables and fruits to a very limited 
extent, and that the rising temperature, so necessary to the 
growth and maturity of vegetables, together with the foul 
exhalations and improper hygienic conditions, contributes 
chiefly to the production of the widespread epidemics of in- 
testinal diseases which annually decimate the infantile popu- 
lation. The influence of these agencies I concede; but I am 
impressed with the conviction that intestinal diseases as fre- 
quently find their cause in that which is ingested as in that 
which is smelled or inhaled. The cause is often something 
more tangible and gustatory than the fetid and subtle ema- 
nations which hygienists have striven so long to define and 
to circumscribe. I am disposed to shield Providence from 
the alleged agency in the causation of many of the " ills 
which flesh is heir to," and to ascribe them to the indul- 
gence of our own insatiate thirst and fondness for the " good 
things of this world." Even among very young children 
the intestinal diseases are frequently directly traceable to the 
ingestion of unwholesome fruits and vegetables ; nor is the 
nursling exempt from the danger, even though the delete- 
rious influence may only reach it through the defective milk- 
supply of the mother feeding upon immature or deteriorated 



ESSAYS AND ADDRESSES. 89 

vegetables and fruits. 1 In this conuection I will briefly invite 
attention to a few admitted facts. Not that I wish to use 
them to maintain any exclusive doctrine of causation, or to 
construct any new theory, but rather to extend the field of 
inquiry and to direct your studies away from a too exclusive 
consideration of the very prevalently received opinions and 
theories in regard to the ever-fermenting and widespreading 
agency of bad-smelling, impure, and foul exhalations, as the 
chief and segregate cause of summer intestinal diseases. 

Intestinal diseases, both among adults and children, are 
comparatively rare in the farming regions, and both classes 
of the rural population, adult and infantile, are more gener- 
ally consumers of fruits and vegetables, and suffer less detri- 
ment therefrom, than like classes of the population of cities. 
Far the larger proportion of infantile intestinal diseases occurs 

1 The influence of lactation, both natural and artificial, in the causation of infantile 
intestinal diseases, is far too frequently overlooked. Milk is the natural aliment of 
young animals, but the nursling is very frequently fed exclusively upon milk wholly 
deficient in the necessary nutrient and healthy constituents, and, indeed, often upon 
it when it is diseased. The unwholesome and sometimes pernicious changes pro- 
duced in the mother's milk by sudden bursts of passion, by a nervous temperament, 
by menstruation and pregnancy, by excessive sexual indulgence, by irregular habits 
of life, and by certain articles of diet, are too well established by clinical observation, 
if not by chemical analysis, to be considered as mere coincidences unworthy of the 
attention and careful scrutiny of the scientific physician. Decaisne {London Lancet, 
September, 1872) has shown that insufficient food may occasion very serious and varied 
disturbances of the quality of the milk. In his report to the Academie des Sciences 
of the results of his observations of forty-three women who nursed their infants 
during the siege of Paris, he deduced the conclusions that some women may, upon 
insufficient diet, produce abundant and rich milk, and their children will thrive , 
while they themselves will emaciate. Another class will produce but little milk, and 
that very poor, and their children will suffer for want of nutriment and sicken with 
choleraic diarrhoea, and a third class will produce scarcely any, and their children 
will die. In syphilitic mothers the proportion of sugar is diminished and water 
increased in the milk ; fever lessens, and may suppress the secretion ; emotion, mental 
anxiety, and sorrow may diminish it or render it poisonous ; puerperal fever seriously 
disturbs its healthy qualities ; insufficient air, sedentary habits, and want of cleanli- 
ness not infrequently impart to it conditions injurious to the health of the nursling. 
Certain drugs administered to the mother may affect the infant. Iodine can be 
detected in the milk ; mercury given to syphilitic mothers will be conveyed to the 
suckling ; opiates and some purgatives will demonstrate their physiological effects 
upon the infant. Lettuce imparts its qualities to the milk, yielding " when inspis- 
sated (Redwood) lettuce opium, or lactucarium." Garlic, the onion, cabbage, turnips, 
and even green clover will impart a distinctive aroma to the milk of cows feeding 
upon them. But more important are the facts that the quality and quantity of the 
milk are dependent upon the character of the food and the vigor and healthfulness 
of the digestion. A meagre diet affects almost exclusively the quantity of butter and 
casein ; a bad diet imparts deleterious qualities. 



90 ESSAYS AJfD ADDRESSES. 

among those beyond the age of six months — that is, subsequent 
to the period at which the natural alimeut is usually consid- 
ered by the laity adequate to the demands of growth and de- 
velopment ; and far the larger percentage of mortality occurs 
among the children of the poor and squalid residents of cities 
— the class necessarily the most indiscreet consumers of cheap 
and deteriorated vegetables and fruits. Statistics establish 
the greater prevalence of these diseases between the ages of 
six and thirty months, and among the artificially fed, and 
greater proportionate mortality in the densely populated dis- 
tricts, and among the children of the poorer classes. Can it 
be that those under six months, those advanced beyond thirty 
months, and those nursed at the breast are less exposed to 
and less impressible by atmospheric influences ? Undoubt- 
edly the intercurrent affections and developmental peculiari- 
ties of the period exercise very considerable influence in 
predisposing to intestinal disease; but, assuredly, improper 
alimentation must constitute the chief among the many fac- 
tors concerned in the etiology. 1 It is then manifest that 
intestinal diseases are most prevalent during the warmer 
months of the year — June, July, August, and September, 
when vegetables and fruits are most abundant and deterio- 
ration most rapid — are proportionately far more frequent 
among communities of consumers who can only obtain sup- 
plies by purchase, and are most fatal among the poor, who 
from necessity become the purchasers of the cheapest and 
most deteriorated. 

These significant facts are not adduced to disprove the 
manifold ill effects of a bad atmosphere and-of fetid exhala- 
tions, but to invite vour attention to the consideration of 



1 Starchy aliments are indigestible in consequence of the feebleness of the diges- 
tive properties of the salivary, pancreatic, and intestinal juices of young children. 
They are also deficient in "materials for the re-integration of the principal tissues, 
which is so necessary to the growing infant." Sonsino established the condition of 
"physiological dyspepsia in infants for starchy aliments." Korowin has deduced the 
conclusion from a series of experiments that the property of the pancreatic juice to 
transform starch into sugar is only manifest after the third month of life, but that 
the parotidean saliva possesses this power from birth. In regard to both secretions, 
this power becomes more active with the development of the child. 



ESSAYS AND ADDRESSES. 91 

another and perhaps as frequent and direct an agency in the 
causation of intestinal diseases ; and to illustrate, as well, the 
comparative innocuousness of fresh, mature, and properly 
gathered fruits and vegetables, as to demonstrate their perni- 
cious and disease-producing qualities as supplied to and con- 
sumed by the inhabitants of cities. 

To elaborate further the distinct question here at issue — 
the agency of immature and deteriorated fruits and vegetables 
in producing intestinal diseases, and the more strikingly to 
exhibit the qualitative changes which they speedily undergo 
after preparation for market — I shall select a few of those most 
generally consumed and describe the mode of gathering, pack- 
ing, and conveying, and their condition when exposed for sale. 

The Irish potato (Solarium tuberosum), perhaps the most pop- 
ular aliment supplied from the " truck farm," when mature 
and properly cooked, is a wholesome and nutritious article of 
diet, carries well, and preserves its flavor and nutrient quali- 
ties, even in very warm weather, for a reasonable time. It 
has a stage of ripeness, marked by a thick and firmly ad- 
herent skin, and when cooked breaks, upon very gentle 
pressure, into a semi-dry, mealy mass. In this condition the 
producer supplies them to his own family. Young children 
consume them with comparative impunity. In the early 
spring we are usually supplied from Bermuda with a variety 
which, as a rule, is in a fair state of preservation ; but the 
general demand and high price soon draw a supply in suc- 
cession from Savannah, Charleston, Norfolk, and the farms 
in the immediate vicinity. The tubers are gathered, not be- 
cause they are ripe, but because they are merchantable — that 
is, have attained sufficient size; perhaps washed, better not, 
packed in barrels and transported to the place of sale. In 
this tender, succulent, and growing state they are easily 
bruised, have a smooth, thin, delicate, and slightly adherent 
surface-covering; and we find them in market with partially 
peeled and ragged surfaces, the loosened parts of the cuticle 
partially attached to the remaining adhering pieces. These 
are the unavoidable results of gathering before maturity, 



92 ESSAYS AND ADDRESSES. 

rough handling, improper packing, and of the heating- 
process — preliminary to other deteriorating changes through 
which they wholly or partially pass before they are exposed 
for sale. The extent of these degenerative changes is pro- 
portionate to the lapse of time and closeness of packing, and 
perhaps also to the mode of transportation. The heating, or, 
rather, steaming, process favors the detachment of the par- 
tially developed cuticle, as it does of the matured skin. I 
need hardly inform you that the destruction or removal of 
the surface-covering which nature provides for protection and 
preservation favors and hastens the decay of all perishable 
fruits and vegetables. Such tubers cook waxy, cut cheese- 
like, bite doughy, and taste greenish and weedy. They are 
served upon our tables with savory dressings and eaten with 
relish, but they are only partially digestible, and, in the main, 
pass from the bowels in white, doughy, unaffected lumps. Of 
the consumers some escape unhurt, some suffer a pang or two y 
others, fortunately, purge freely, but the less fortunate suffer 
more seriously. To many young children, whose digestive 
powers are inadequate to the complete digestion of any starchy 
aliment, these tubers, mashed and commingled with savory 
gravies, are fed as choice and nutrient morsels, and when 
sickness and suffering come, the temperature — not above 70° 
at mid-day — or some distant slaughter-house or bone-boiling 
establishment is charged with the dire calamity. The potato 
probably ripens from exterior to centre; hence, after cooking, 
it may frequently be observed that immediately under the 
apparently ripened skin a layer of greater or less thickness, 
according as the stage of ripeness has advanced, of a semi- 
dry, farinaceous mass, will scale from a firm and waxy cen- 
tral portion, so that one may be deceived by the manifest 
external evidences of ripeness. The potato deteriorates by 
growing out or germinating. If left in the ground long after 
maturity, during a growing season, from one or more of the 
buds or eyes will grow appendages resembling in every re- 
spect the mother-tuber — they are, in fact homologous out- 
growths. The presence of such a tumor is the evidence of a 



ESSAYS AND ADDRESSES. 93 

second growth, and if broken off, as is usually the case when 
offered for sale, the surface is denuded at the point of attach- 
ment, When improperly stored, and especially duriug the 
later spring months, the tubers germinate, and from each eye 
rootlets shoot forth, which are likewise broken off before being 
exposed for sale, but the surface exhibits no denudation, and 
the condition can only be detected by a very careful inspec- 
tion of the buds, and, perhaps, a softer feel. The density 
may have diminished because of the commencement of germi- 
nation. Freezing destroys the organization of the potato, 
and with thawing the putrefactive changes begin. Notwith- 
standing, it is a very common occurrence for dealers to offer 
and for consumers to purchase frozen potatoes. " The potato," 
says Pavy, " is made up of cells, penetrated and surrounded 
by a watery, albuminous juice, and filled with a number of 
starch-granules." Cooking coagulates the albumin, and the 
starch-granules absorb the watery part ; hence the cells are 
distended, and their cohesion being destroyed the potato 
breaks down into a " loose, farinaceous mass." " Young 
potatoes " (Chambers's Manual of Diet, p. 43), " from not so 
easily breaking up, require long mastication to render them 
soluble, and are not then very digestible; but old, waxy 
potatoes are worse, for they seem to unite again into a sticky 
mass after being swallowed, and remain for hours undis- 
solved." The worst of all are potatoes affected with disease. 
The potato contains 1 per ounce (437.5 grains), in its natural 

1 Percentage-amount of ash 1 to 1.5. Mineral constituents in 100 grains of ash : 

Way. Fromberg. 

Potash 46.60 50.23 

Soda 3.7 

Magnesia 8.70 4.4 

Lime 4.54 0.83 

Phosphoric acid 13.30 10.10 

Sulphuric acid 4 66 14.67 

Chloriae of potassium 17.76 

Chloride of sodium 3.43 

Carbonic acid (from the incineration of the or- 
ganic acids) 13.30 

Oxide of iron 

Silicate of alumina 1.95 

— Parkes, Pract. Hygiene, 4th ed., p. 236. 



94 ESSAYS AND ADDRESSES. 

state, 324 grains of water, 1 of nitrogen, 49 of carbon, and 
4.4 of salts. These elements vary much (Smith) with the 
season, variety, ripeness, and soil. The nutrient value of the 
potato is determined by its specific gravity ; l the heavier any 
given tuber is according to its size the greater amount of 
starch it contains. The relative proportion of solid constitu- 
ents can be ascertained (Parkes, p. 237) by multiplying the 
specific gravity by a factor taken from the table, 2 and if it 
be desirable to ascertain the percentage of starch, multiply the 
specific gravity by the factor less 7. If the specific gravity 
of the potato is below 1068, the quality is bad (Parkes). 

Between 1068-1082, the quality is inferior. 

Between 1082-1105, the quality is rather poor. 

Above 1105, the quality is good. 

Above 1110, the quality is best. 

The potato should be cooked with the skin on, and well 
boiled or thoroughly steamed, otherwise the starch is not 
easily digested ; and if the cooking-process is rapid, the cellu- 
lose and albuminates become hard. For the sick, Chambers 
(loc. cit. } p. 244) prescribes the following method: 

" Boil one pound of potatoes with their jackets on till they 
are tender or brittle. Peel them, and rub them through a 
fine sieve ; when cool add a small teacupf ul of fresh cream 
and a little salt, beating the puree up lightly as you go on 
till it is quite smooth, and warming it up gently for use." 

With a knowledge of the structure and composition of the 
tuber it is easily understood why bruising, peeling, germina- 
tion, and freezing should promote degenerative change. Any 
change which increases its very large proportion of water 

1 This may be ascertained by throwing several potatoes into a strong solution of 
salt, and then adding water until some of them sink, and others swim. The specific 
gravity of the solution will represent that of the potatoes as a whole. Smith, Food, 
p. 199. 

2 Specific gravity Specific gravity „ 

between Factor - between Factor - 

1061-1068 ... 16 1105-1109 ... 24 

1069-1074 ... 18 1110-1114 ... 26 

1075-1082 ... 20 1115-1119 » « 27 

1083-1104 ... 22 1120-1129 ... 28 



ESSAYS AND ADDRESSES. 95 

diminishes its relative nutritive quality aud hastens the de- 
structive process. The tuber should be firm and cut with 
crispness. The chief value of the potato lies in its antiscor- 
butic properties. " Ten grains (Smith) of potato consumed in 
the body produce heat sufficient to raise 26 pounds of water 
1° F., or to lift 1977 pounds one foot. 7 ' 

The pea (Pisum sativum), as a fresh vegetable, is eaten 
unripe, but should have reached the stage of maturity when 
the seed-husk is filled. It, like the potato, comes first from 
the far South, and successively from nearer regions. As a 
fresh vegetable pease bear transportation badly, soon wilt, 
heat, wither, shrink, fade, and deteriorate after having been 
gathered and packed. It is a tedious crop to gather and a 
bulky product to transport. The producer gathers his table- 
supply during the forenoon, perhaps before the morning sun 
has evaporated the dew from the leaves and seed-pods. Upon 
his table the pea is a delicious, inviting, and richly flavored 
vegetable, seeming to dissolve during the process of mastica- 
tion, and digests without inconvenience. For the market 
the crop is more frequently gathered when too far advanced 
toward ripeness than before the fitted stage of development 
— and for the obvious reason that transportation is better 
borne and the loss is less from shrinkage. Usually the gath- 
ering is done during the heat of the day, because of less injury 
to the vine while wiltering under a blazing sun ; but the pru- 
dent farmer never enters his pea-patch until the gathering is 
ready for his " pickers " — that is, when the hand can pluck 
a number of pods at a single grasp, for he wisely estimates 
the cost of time lost in clutching at single pods, and knows 
too well that the loss in price by a few days' delay will be 
abundantly made up by the increased measurement from the 
too far advanced and ripened seed-pods. Thus gathered, 
they are immediately packed in barrels and transported to 
market. Very speedily the heating-process begins, and during 
a few hours the temperature in the centre of such a bulk will 
rise considerably above blood-heat, and when emptied upon 
the salesman's stand the subsequent morning the loosened 



96 ESSAYS AND ADDRESSES. 

bulk will emit -an amazing volume of smoke — condensing 
steam ; or perhaps more time has elapsed, and the heating- 
process has been completed, succeeded by other destructive 
changes. The seed-pods have lost their fresh and pea-green 
color, their crispness and resiliency; have faded and with- 
ered — flattened, as the salesman will tell you, by pressure, but 
in fact by the loss of natural moisture expelled by the steam- 
ing -process. The contained seeds, the only edible portion, 
have lost entirely their peculiar luscious flavor, have acquired 
toughness and, to a greater or less degree, hardness, and the 
seed-husk no longer submits to ordinary digestion. Each 
seed must be crushed between the molars, or else may roll 
through the alimentary canal, except for the preliminary 
cooking, conditioned for a vigorous vegetation. The seed- 
pulp contains all the nutrient qualities, but cannot be sepa- 
rated from the husk in the green state. The husk acquires 
firmness as the seed-pulp progresses to complete development, 
and loses color through the ripening-process. It is better to 
select for the table undeveloped rather than past-developed 
peas, and small, immature pea-green pods rather than the 
faded and ripening ones. The peculiar greenish hue is an 
essential characteristic of freshness. 

" They should (Chambers) be young, and their skins tender 
enough to crack in boiling." In such condition they are 
sweet, easily digested, but less nutritious than when fully 
matured. " When old (Chambers, Pavy) no amount of 
boiling will soften them ; indeed, the longer they are boiled 
the harder they become." 

When dried they are deprived of their husks before cook- 
ing, and when thoroughly boiled constitute a good article of 
diet for those blessed with vigorous digestion. 

Composition of the Dried Pea (Paye n). 

Nitrogenous matter 23.8 

Starch, etc 58.7 

Cellulose 3.5 

Fatty matter 2.1 

Mineral matter 2.1 

Water 8.3 



ESSAYS AND ADDRESSES. 97 

Beans. Beans are even more perishable than pease. As a 
fresh vegetable, both pods and seed are edible, and in their 
highest perfection for the table they must be young, fleshy, 
brittle, and tender. The succulence and fleshiness of the pods 
invite destructive changes, and in bulk, closely packed, rot 
soon begins. Hence it becomes the interest of the distant 
grower to delay the gathering beyond the stage of dietary 
perfection; and, consequently, of the city consumer to pur- 
chase his supplies from the growers of his vicinage. Beans 
should be packed loosely in small bulk and in crates. A 
coarse vegetable at best, but nutritious aud harmless when in 
proper condition. They are cheap, and therefore popular 
among the poorer classes. As the pods ripen color fades, 
dryness increases, and they become tough and tasteless. Cattle 
will not eat them. Even when gathered in proper condition 
and properly packed deterioration soon begins, aud, though 
not actually rotten, the loss of succulence and brittleness 
denotes changes which unfit such pods for table-use. 

Beans are sometimes improperly eaten as salad, in the 
preparation of which vinegar should never be used, for it 
renders the legumin insoluble, and thus prevents digestion. 

Composition of Dried Beans (Payen). 

Horse bean. Windsor bean. 

Nitrogenous matter 30.8 29.05 

Starcb 48.3 55.85 

Cellulose 3.0 1.05 

Fatty matter 1.9 2.00 

Saline matter 3.5 3.65 

Water 12.5 8.40 

100.0 100.00 

The legurninosse are rich in nitrogenous matter, and ap- 
proximate in nutritive value the products of the animal 
kingdom. They possess the special advantage of combining 
sulphur and phosphorus with the vegetable casein ; but in 
consequence of the indigestibility of the legumin about 6.5 
per cent, is lost, and escapes with the excrementitious matter, 
and much flatus (Parkes) is also produced by the formation 

7 



98 ESSAYS AND ADDBESSES. 

of sulphuretted hydrogen. In combinatiou with other starchy 
or fatty aliments they constitute valuable articles of diet. 
Bacon and beans in this country, as in England, has been a 
favorite dish, especially among the laboring-classes, who are 
accustomed to much exercise and continuous labor. 

Tomatoes. The tomato (Solanum ly coper sicum), so univer- 
sally and deservedly popular among all classes of consumers 
of vegetables, when ripe and gathered and packed with ordi- 
nary care, bears carriage well, and is usually supplied to city 
consumers in great perfection. Those brought, in early 
spring, from the remote South have been gathered green, are 
packed with very great care, each wrapped in a separate piece 
of paper, and are thus ripened on their journey. Those sup- 
plied from the near vicinity, after a killing frost has bared 
the earth of all summer vegetation, have been ripened under 
glass. When the chilling wind and falling thermometer 
threaten frost the grower hastens to save the green fruit 
upon the vines. It is hastily gathered and put under glass 
and thus colored red — not, in fact, matured. Such fruit 
possesses but little of the attractive flavor and nutrient quali- 
ties which belong to the matured and naturally ripened fruit; 
but it finds ready sale, and is offered to the consumer in 
the best condition attainable. It is the business of the pro- 
ducer to supply the demand, and it is no fault of his if the 
luxurious palates of city consumers are only to be satisfied 
with green fruit colored red. I regard the tomato as a 
healthy, agreeable, and nutritious vegetable, but have no 
confidence in its cholagogue or blood-purifying qualities, as 
very many of the laity believe and some physicians claim. 
In the flesh reside all the nutritive and gustatory qualities, 
hence they should always be peeled preparatory to being 
eaten. The preliminary degenerative change is fermentive, 
which rapidly progresses to the complete destruction of all 
the fleshy part, leaving nothing but the seed and thin but 
tough skin. Neither seed nor skin is digestible. Feed hogs 
upon tomatoes and scatter the manure from the sty upon a 



ESS ATS AND ADJDBESSES.. 99 

barren field,, and tomato-plants will flourish like noxious 
weeds. Commingle the refuse skins with slop, and the 
hog will carefully avoid them, leaving them in the vessel 
from which he feeds. Eot will very slowly destroy tomato- 
skins. Throw them into a cesspool, and they will offer an 
obstinate resistance to the putrefactive process. They dis- 
appear through disintegration by dryness. Xotwithstanding 
all this, some foolish people will insist that the choicest part 
of this popular vegetable is the skin, and not infrequently I 
have known young children to be fed upon the sliced fruit 
without previous peeling or ordinary care to avoid the in- 
gestion of the seed. 

The following analysis 1 is by Dr. B. F. Craig, of this city : 

"A can of tomatoes was found to contain 2.04 pounds 
avoirdupois, of which, however, only 0.05 pound (22.75 
grains) were solid matter, dried at 212° F. There was, 
therefore, 97.6 per cent, of water present. 

'- The acid of the tomato I found to be malic, with a trace 
of citric, the amount of the free malic acid being equivalent 
to 315 parts in 100,000, or a little over three-tenths of 1 
per cent. (Lemon-juice contains about twenty-five times as 
much free acid.) In tomatoes there is about as much more 
malic acid in combination with bases. 

" The amount of vegetable acid — its proportion to the total 
solid matter — is of itself enough to make tomatoes valuable 
as an antiscorbutic ; but it certainly seems desirable, in can- 
ning them, to get rid of the great excess of water." 

Chambers regards the tomato as a healthy but not a sub- 
stantive article of diet, and Pavy regards it more as a relish 
than a nutritive element. Surgeon Swift would regard it as 
an addition to the army ration of great value, if the excess 
of water could be disposed of. 

Tomatoes may be eaten cooked or sliced raw as a salad with 
oil and vinegar ; and are easily digested when ripe, but when 

1 Circular Xo. 8, Report on Hygiene, xxxix. 



100 ESSAYS AND ADDRESSES. 

green are flatulent. Their only medicinal property is exclu- 
sively derived from the very limited quantity of malic acid, 
and it may be defined as mildly antiscorbutic. 

Cucumber (Cucumis sativus). Perhaps no one member of 
the family of kitchen garden vegetables has so many greedy 
devourers as the cucumber. There is something so refresh- 
ing and exhilarating about the appearance of a dish of sliced 
cucumbers prepared for the table, and something so attrac- 
tive to the palate in its peculiarly inviting and mouth-water- 
ing aroma, that one's self-denial oftentimes fails to protect 
the stomach from the indigestible mass, and consumers fail 
to appreciate the fact that they are vigorously masticating an 
aroma, deriving but little if any sustenance. Why preferred 
for the table before maturity I do not know. Swine, I be- 
lieve, select the full-grown and matured fruit, ripened to a 
golden-yellow color, as the choicest, and certainly the aroma 
is more decided and the juicy constituent is most abundant 
at maturity. For home-consumption it is gathered in early 
morning, while chilled by the morning temperature, and 
either immersed in cold water or kept in a cool place until 
prepared for the table. Not easily digested at best, yet those 
who eat them with such avidity are very unwilling to acknowl- 
edge any after ill-effects, and it is assuredly true that country 
consumers usually escape merited suffering. The cucumber 
carries well, resists decay, withers slightly, loses some in 
crispness and brittleness, and acquires toughness, but retains 
flavor for some days, and is usually offered for sale in a 
fair state of preservation. Without presenting manifest 
evidences of destructive change, it speedily undergoes some 
alteration which renders it exceedingly hurtful to healthy 
digestion and provocative of intestinal trouble. It would 
seem that these evil effects were proportionate to the loss of 
the watery constituent, and thus gathering during the heat 
of the day, exposure, and the lapse of time promote those 
changes which so seriously impair its dietary qualities. 

Cucumbers, like celery, says Chambers (loo. cit., p. 49), are 



ESSA YS AND ADDRESSES. 1 01 

not suitable for eating raw after a full meal. The quantity of 
woody fibre in them cannot be digested. " With bread and 
cheese, as a light lunch, they give an agreeable zest, and seem 
to stimulate the secretion of gastric juice. " " Stewed they 
form (Pavy) a light and wholesome vegetable." u When 
made acid with vinegar and eaten in a large quantity (Smith) 
they cause pain at the stomach." Some have supposed that 
the unwholesome property resided in the skin, others located 
it in the juice. It usually repeats its flavor in the mouth 
some time after having been eaten. 

The brassica tribe, which includes all the varieties of the 
cabbage — Brussels-sprouts, cauliflower, broccoli, and kale — 
are highly esteemed as vegetable aliments by many per- 
sons, and especially by the laboring-classes, who rank 
them as highly nutritious, usually styling the cabbage as 
" strong food." In this respect, however, the popular esti- 
mate is far above their true value as food. There may be 
very wide differences in the chemical composition of the sev- 
eral species of this family of vegetables, but for all practical 
purposes cabbage may be assumed to represent the type of 
the class. It contains in 100 parts: 

Water 91.0 

Albuminates 0.2 

Fats 0.5 

Carbohydrates 5.8 

Salts 0.7 



" Ten grains of cabbage (Smith) when consumed in the 
body produce heat sufficient to raise 1.12 pounds 1° F., 
which is equal to lifting 834 pounds one foot high," thus 
representing less than one-half the power of an equal amount 
of potato. Even this very feeble nutritive property varies 
according to the stage of growth and maturity of the plant. 
Anderson has determined these variations as follows : 

Young Ripe outer Ripe heart- 
plant, leaves. leaves. 

Water 91.8 91.1 94.4 

Nitrogenous matter .... 2.1 1.6 0.9 

Woody fibre, gum, and sugar . . 4.5 5.00 4.1 

Ash or salts 1.6 2.2 0.6 



102 ESSAYS AND ADDRESSES. 

It thus becomes manifest that as the plant advances to ma- 
turity its nutritive property diminishes, and that the matured 
and bleached heart-leaves, usually selected as the choicest 
parts, and largely consumed as a salad in the form of " cold- 
slaw," consist of little else than water and woody fibre. 
The very large proportion of these two constituents not only 
diminshes its value as an alimentary product, but renders it 
very difficult of digestion, and hence inadmissible as an 
article of diet when the digestion is enfeebled by disease or 
other conditions. Life could not be sustained but for a brief 
period upon this class of substances, for the digestion and: 
capacity of the stomach would prove inadequate to the wants 
of the system. The tribe as a whole may be very properly 
styled the hay of the human race ; but in fact they are less 
valuable as alimentary substances, containing less oily and 
nitrogenous material. " Their proportion of sulphur (Pavy) 
is large, and they thus are apt to give rise to flatulence of an 
unpleasant nature." For the table they should be young, 
fresh, and green (brocoli should be white) ; blanching is the 
evidence of loss of nutritive qualities, 

" If the cabbage has begun to heat from fermentation 
(Chambers), it is most noxious, and generates in the intes- 
tinal canal an enormous amount of flatus, consisting not only 
of the usual carbonic acid, but of sulphuretted hydrogen." 
Fermentation destroys the antiscorbutic qualities for which 
the cabbage is so highly prized, and in which consists its 
chief value as an aliment. This property diminishes with 
loss of freshness and crispness. 

It is the common belief that cabbage deteriorates very 
slowly, and this prevalent opinion enhances the cupidity of 
the tradesman. The purchaser buys the largest head for the 
smallest amount of money, and distributes his mess of bacon 
and cabbage through as many meals as his daily subdivisions 
will admit, and hopes to restore freshness and crispness by 
continuous immersion in water, forgetting that he is thus 
diluting his 5 per cent, solution of woody fibre and feeding 



ESSAYS AND ADDRESSES. 103 

himself on bad water and noxious gases. If one will have 
cabbage to season his bacon and pork, purchase the heads 
fresh, unstripped of the green and most nutritious leaves, 
and buy it daily from the producer, and not from the huck- 
ster when old and blanched, with 94 per cent, of water and 
but nine-tenths of 1 per cent, of nitrogenous material. On 
such substances nursing-women feed to make rich milk, and 
puny babies are fed to promote vigor and growth. The dis- 
agreeable, penetrating,- and tenacious odor of boiling cabbage 
ought to banish it from the kitchen. 

The turnip (Brassica napus) belongs to the cabbage-tribe. 
It is less nutritious than the young, fresh, green cabbage, but 
more so than the matured and blanched heads. 

Composition of the Turnip (Letheby). 

Nitrogenous matter 1.2 

Starch, etc 5.1 

Sugar . 2.1 

Salts ; - 0.6 

Water 91.0 

One pound of turnips (Smith) contains : 

Swede. White. 

Carbon 30.4 grains. 17.3 grains. 

Nitrogen 15.3 " 11.2 " 

Dr. H. C. Bastian, in his experiments on spontaneous gen- 
eration, made much use of a solution of turnip as being an 
especially favorable medium for the growth of bacteria and 
other microzymes; and my friend, Dr. J. S, Billiugs, U. S. A., 
in repeating Dr. Bastian's experiments, found that bacteria 
developed more rapidly in a solution of the turnip than in 
any other medium employed by him. This fact may be of 
but little value as a proof of the speedy deterioration of the 
turnip ; but in view of other researches, as yet, perhaps, not 
determiuative of any practical conclusion, the interesting in- 
quiry presents itself — What relation does the development of 
bacteria bear to the degenerative change which vegetables and 
fruits undergo, and how far such microzymes may be con- 
cerned in the causation of disease? Accepting the researches 



104 ESSAYS AND ADDRESSES. 

of M. Pasteur that " putrefaction is a fermentation deter- 
mined by infusoria of the family of vibrios and by bacteria," 
and the farther conclusion, deducible from the researches of 
M. Davaine, that septic matter owes its toxic properties to 
the development of bacteria, it requires but little stretch of 
the imagination to conceive how purulent infection might 
follow the introduction into the system of bacteria generated 
during the process of vegetable decomposition, unless it be 
maintained that such infusoria differ in their virulence from 
those of septic matter. This is but a passing suggestion. 

Like cabbage, the turnip is not easily digested. Age and 
germination diminish its nutritive quality and lessen its 
digestibility. As an aliment it is less valuable than either 
the carrot or the parsnip. 

Composition of the Carrot (Lethe by). 

Nitrogenous matter 1.3 

Starch, etc 8.4 

Sugar 6.1 

Fat 0.2 

Mineral matter 1.0 

Water 83.0 

" Ten grains of carrot (Smith) when consumed in the body 
produce heat sufficient to raise 1.36 pounds of water 1° F., 
which is equal to lifting 1031 pounds one foot high," exceed- 
ing the power of an equal amount of cabbage 197 pounds, 
and 946 pounds less than an equal amount of potato. 

Composition of the Parsnip (Lethebt). 

Nitrogenous matter 1.1 

Starch, etc. 9.6 

Sugar 5.8 

Fat 0.5 

Salts 1.00 

Water 82.0 

The parsnip and carrot (Smith) require from two and a 
half to three and a half hours to digest. 

Contrary to the popular belief, the turnip, carrot, and pars- 
nip are more easily digested and more valuable as aliments 
than the cabbage ; and it is remarkable that the parsnip 



ESS A YS AND ADDRESSES. 105 

and carrot are not more generally used. Both are produc- 
tive crops, carry well, are easily preserved, and do not 
deteriorate rapidly. When tough and fibrous they should 
be rejected. When overgrown they are apt to be hard in 
the centre. The carrot is more nutritious in proportion to 
thickness of the " soft, outer, red, than the central, yellow, 
core-like part." 

The cantaloupe is especially illustrative of the rapidity 
of deterioration, and of the marked and sudden transition 
from the stage of perfect maturity to one of decay, and these 
changes progress more rapidly if left, after maturity, attached 
to the vine and exposed to the air and sunlight than when 
gathered and properly sheltered. The experienced grower 
knows precisely at what stage of ripening to gather to suit 
his method and the distance of transportation. If distant a 
night's journey in a wagon or a few hours by rail or water, 
they can be offered for sale in the city in perfection. But 
there is art in growing as well as tact in gathering the canta- 
loupe. It should be regular in shape ; have a well-netted 
and deeply furrowed surface, and thick rind ; possess the 
well-recognized, penetrating, and tenacious fragrance ; and 
be thick and firm fleshed, juicy, and high flavored. Deformed 
and irregularly shaped melons are wanting in flavor ; past 
ripened, lose flavor and firmness; insipidity is in proportion 
to softness and pultaceousuess. A deep-yellow-colored canta- 
loupe should not be permitted to be sold in any market. In 
its highest state of perfection it is delicious, nutritious, and 
healthy fruit; in its past-ripened, decaying condition very 
unwholesome. No cantaloupe in a state of perfection to-day 
can be kept in a proper condition until to-morrow by any 
process known to me. The flattened and blanched under 
surface is always defective in flavor and other essential quali- 
ties. 

It may be permissible, though not strictly relevant, to refer 
to the quality especially illustrated by this melon, which, as 
expressed in ordinary parlance, some fruits and vegetables 



106 ESSAYS AND ADDRESSES. 

possess of imparting their peculiar and characteristic flavor, 
and odor also, to certain oleaginous articles of diet, when 
packed together in wholly or partially air-tight compart- 
ments. It is, perhaps, more properly the absorption by such 
substances of the volatile oils which give to vegetables and 
fruits their aroma; and hence the impregnation of milk, 
butter, and other oleaginous substances with the flavor of 
certain fruits and vegetables is due to the facility and extent 
of such absorption of the volatile oils. How far this may 
affect the nutritive and digestible qualities of such articles I 
do not know. It may also be added that certain vegetables 
grown in near proximity reciprocally impoverish the flavor 
of each — for instance, the squash, pumpkin, or gourd, grown 
sufficiently near the cantaloupe, will destroy the flavor of the 
latter. 

Fruits. There are a few general observations applicable 
to fruits which I may be permitted to epitomize from the 
recent work of Prof. Pavy on Food and Dietetics. Fruit is 
a modification of the leaf, and in the green state exhibits 
much of its chemical composition. As maturity advances 
special characteristics develop. At first, like other green parts 
of the plant, the fruit absorbs and decomposes the carbonic 
acid of the atmosphere, liberating oxygen and assimilating 
the carbon. As the ripening progresses oxygen is absorbed 
and carbonic acid given off, and some of the proximate prin- 
ciples contained in the unripe fruit, particularly the acids and 
the tannin, in part disappear, apparently by oxidation. At 
the same time the starch undergoes transformation into sugar, 
and the insoluble pectose into pectin and other soluble sub- 
stances. In this manner the fruit arrives at a state of perfec- 
tion. But as oxidation advances the sugar and remaining acid 
become destroyed, flavor diminishes, and deterioration sets 
in ; and if these changes are allowed to pursue their ordinary 
course, the pericarp undergoes decay and the seed is set free. 
It is thus manifest that the stage of complete ripeness is 
quickly followed by degenerative changes, which rapidly 



ESSAYS AND ADDRESSES. 



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108 ESSA YS AND ADDRESSES. 

progress to the entire destruction of the sarcocarp, unless, by 
some method of preservation, the oxidation can be arrested 
at the stage of ripeness. 

Composition of the Pulp of Eipe Bananas. 

Nitrogenous matter 4.820 

Sugar, pectose, organic acid, with traces of starch . . .19.657 

Fatty matter 0.632 

Cellulose 0.200 

Saline matter 0.791 

Water 73.900 

These analyses show that fruit, in consequence of the small 
quantity of nitrogenous matter and the very large proportion 
of water which it contains, is not entitled to very high rank 
as a nutritive aliment " While advantageous (Pavy) when 
consumed in moderate quantity, fruit, on the other hand, 
proves injurious if eaten in excess; of highly succulent na- 
ture, and containing free acids and principles prone to undergo 
change, it is apt, when ingested out of due proportion to other 
food, to act as a disturbing element and excite derangement 
of the alimentary canal. This is particularly likely to occur 
if eaten either in the unripe or overripe state: in the former 
case, from the quantity of acid present ; in the latter, from 
its strong tendency to ferment and decompose within the 
digestive tract. " 

The cultivated fruits are more nutritious than the wild, the 
quantity of sugar being considerably augmented, and the 
amount of insoluble matter, skins, and seeds being greatly 
lessened by careful cultivation. To the succulence is due the 
rapidity of degenerative changes. Berries and cherries soon 
ferment ; the latter even when fresh are* apt to disorder the 
bowels. 

The strawberry-season does not properly, in any particular 
locality, extend beyond thirty, but in our northern cities it 
not infrequently runs through sixty, and perhaps even 
ninety, days. Since the introduction of improved varieties 
and more intelligent culture, with careful gathering and 
packing in small, open baskets in crates, favored by the 



ESSAYS AND ADDRESSES. 109 

rapidity of transportation, the berries can be supplied to con- 
sumers at greater distances from the localities where grown, 
in a condition quite equal to the demand of a prudent and 
healthy consumption. Good strawberries should be plump 
and firm, with a dry and unbroken surface, and should not 
be separated from the cap until prepared for use. Rough 
and unnecessary handling, bruising, moisture, and bulk pro- 
mote fermentation and speedy decay. Capped berries will not 
long resist destructive change, and neither bulking on the 
salesman's stand, nor sale by any fixed measure, should be 
permitted in any market. 

Strawberries, like all very small-seeded fruits, not excepting 
the blackberry, so much valued by many for its alleged astrin- 
gent properties, are laxative in their tendency. The seeds are 
absolutely indigestible, and pass through the bowels unin- 
jured by the digestive fluid. To this quality, to their locally 
irritating influence upon the mucous membrane of the alimen- 
tary tract, and to their liability to cling to the folds of and 
find lodgement in the innumerable crypts of the membrane, 
add the deleterious influence of the fleshy part in a state of 
fermentation and decay, and surely nothing more is needed to 
admonish you of the danger of ingesting such deteriorated 
fruit. These small-seeded fruits are especially objectionable 
when fed to young children, to whom they are frequently 
given during the period when the follicular apparatus of the 
digestive tract is undergoing rapid evolution, and perhaps dis- 
turbed in its normal progress by some one or more of the 
coincident developmental operations. Strawberries contain 
much less insoluble matter (seeds and skins), and much more 
sugar than either the blackberry or raspberry; carry better than 
the latter, and equally as well as the blackberry. The raspberry 
when fully ripe degenerates very soon and rapidly after being 
gathered and packed for market, and is very rarely offered 
for sale before deterioration has commenced. This is due to 
the delicacy of the skin and the absence of the caps, which 
render it easily compressed by light pressure and careless 



110 



ESSAYS AND ADDBESSES. 



packing. It bears transportation badly, and only when 
packed in very small bulk. 

The tendency of the berry family 1 to speedy fermentation, 
when packed for transportation, is due to the large propor- 
tion of free acid, structure, and delicacy of the skin which, 
does not afford protection against injury from even very light 
pressure and very careful handling. This tendency is spe- 
cially manifest in the raspberry and mulberry. 

These analyses do not sustain the popular estimate of the 
relative nutritive value of several varieties of fruits. The 
peach and apricot, so universally esteemed because of their 
luscious flavor and comparatively easy digestion, are in fact 
less valuable than others less attractive and palatable. Like 
the plum and the pear, they are rich in pectous substances, 
which mask the free acid, but do not add much to their ali- 
mentary value. Wholesomeness is not necessarily in propor- 
tion to the nutritive value, but to the digestibility and adap- 
tation to the condition and wants of the animal economy. 

In the table below the proportions of soluble and insoluble 
constituents, and of the seeds and skins, have been arranged 
so as to exhibit with approximate accuracy the relative value 
as aliments of the several kinds of fruit. The table is based 
upon the assumption that in the soluble elements reside, for 
the most part, if not entirely, the nutritious properties. The 

Proportions of Soluble and Insoluble Constituents. 



















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9.64 


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Insoluble, 


88.0 


87.15 


91.31 


82. 76.90. 40 


90.62 


77.6388.88 


91.70 


90.36 


91.1992.02 


85.9790.69 


Seeds, skins 


1.80 


3.81 


5.95 


5.93 5.26 


5.61 


2. 59 2. 99 


3.94 


1.96 


4.10 5.21 


0.9012.86 



1 Strawberries, raspberries, mulberries, and blackberries are not properly berries, 
tbough classed as such here. 



ESS A YS AND ADDRESSES. Ill 

seeds and skins are insoluble, and but partially, if at all, 
digestible. As aliments, each kind must be considered not 
only in reference to the relative proportion of soluble and 
insoluble constituents, but in regard also to the proportion of 
seeds and skins which is necessarily ingested with the soluble 
and nutritive elements. The peach contains 9.38 per cent, of 
soluble constituents, and 5.61 per cent, of seed and skin, but 
the latter are usually removed from the edible portion, 
whereas the gooseberry contains 11.12 per cent, of soluble 
material and 2.99 per cent, of skin and seed, which, as a 
rule, are never removed, but ingested with the pulp, and 
consequently, while richer than the peach in nutritive prop- 
erties it is less wholesome, because of these indigestible con- 
stituents. The strawberry contains 9.64 per cent, of soluble 
elements, but 1.96 per cent, of seeds and skin and 1.13 per 
cent, of free acid, and must be accepted as the healthiest of 
the berry family, notwithstanding the mulberry is richer in 
soluble constituents and contains but 0.90 of seeds and skin. 
The large proportion of free acid in the mulberry (1.86), 
though masked by 2.03 per cent, of pectous substances, pro- 
motes speedy fermentation, and even when eaten freshly 
gathered from the tree this action is set up, usually speedily 
followed by some derangement of the bowels. 

If the nutritive value of the several varieties of fruits is 
estimated according to the amount of nitrogenous matter 
(albuminates) each contains, it is very little, and would vary 
between 0.90 per cent, found in the cherry and 0.19 per cent, 
found in the plum. The cherry and the grape are richest in 
nutritive properties, in soluble constituents, and contain less 
water, yet there is a great difference in their wholesomeness 
as aliments. The grape contains but 0.49 per cent, of pec- 
tous substances, but is ingested without the skin ; the cherry 
contains 2.28 per cent, of pectous substances, and is eaten 
with the skin ; but the skin and seed of the grape do not 
aggregate more than half of the percentage of the skin and 
seed of the cherry. Whether the difference in digestibility 



112 ESS A YS AND ADDRESSES. 

is due to the difference of chemical constitution or to the 
parts ingested has not been determined, but it suggests more 
care in avoiding the ingestion of the seeds and skins of fruits. 

Grapes bear transportation well in unbroken bunches, cher- 
ries badly at best, but should never be detached from the 
stems until being eaten. 

These examples are believed to be sufficient to satisfy you 
of the necessity of the inquiry to which I invite you ; but, 
as yet, the picture is far from complete. Before proceeding 
to describe the process of freshening stale vegetables and 
fruits, now so generally practised by market-dealers, I must 
briefly refer to the market-system in operation in many 
American cities, which I hold is not only wrong in itself, 
but productive of greater wrong upon the communities. 

Market-systems. In many of the larger cities of this coun- 
try there is a class of dealers, generally known as " huck- 
sters," who stand between the producer and the consumer. 
They purchase from the producers fresh vegetables and fruits 
in large quantities, at prices far below the rates paid by con- 
sumers, always overstock themselves in quantity and variety, 
preferring to carry over to another market-day the surplus 
rather than lose the opportunity of accommodating a cus- 
tomer. Having, by a system of market-regulations estab- 
lished by municipalities in their generous zeal to promote 
business and to foster trading, secured, through the payment 
of a bonus, the right of occupancy, upon the payment of an 
annual rental, of all the stalls in the regular market-places al- 
lotted to the sale of fresh vegetables, they establish a monopoly 
so exclusive that the husbandman cannot penetrate any nearer 
than the nearest curb-line or footwalk, and there, if at all, 
offer his products for sale ; otherwise he must compete with 
the monopolist at public auction, in bonus bidding, for a 
suitable stand under shelter. The huckster's capital consists 
in his right of occupancy thus secured, perhaps a horse 
and wagon, and a very small amount of money. He pur- 
chases to sell and promises payment after sale. Competition is 



ESSAYS AND ADDRESSES. 113 

consequently not between the dealers to secure the choicest and 
freshest products, but between the growers to secure a pur- 
chaser. Far from his garden with his wagon and team, he 
wisely submits to a sacrifice rather than return with his per- 
ishable commodities. This bidding for a purchaser does not 
enure to the benefit of consumers; it simply enhances the 
profits of the dealers. Hucksters have little or nothing at 
risk, and deal exclusively for the profit; and if supplied 
from the surplus of the previous day, buy only to freshen 
their wilted and decaying stock. In brief, the system — 

1. Regulates the supply by separating the producer from 
the consumer. 

2. Enhances prices to the consumer, without benefiting 
the producer. 

3. Compels consumers to purchase stale, if not deteriorated 
vegetables, because the supply is controlled by middlemen, 
and not by amount produced. 

4. Supply and demand do not bear their proper trade 
relationship, because supply can only reach consumers through 
middlemen who control the only channels of trade. 

5. Consumers cannot make quality a basis of value, for 
the good and bad are mixed. The fresh is made to sell the 
stale. 

"Freshening" Fruits. The system of freshening green 
vegetables is extensively employed by many dealers in per- 
ishable vegetables and fruits, and is so cunningly devised and 
adroitly executed that it will escape any but the most careful 
and cultivated observation. It can be most practially ex- 
posed by individual and descriptive illustrations. Cabbage 
and lettuce are freshened by stripping off the external layer 
of leaves and clipping the end of the foot-stalk, and this pro- 
cess is repeated from time to time until the head is either sold 
or is so reduced in size as to become unmerchantable. The 
process of stripping brings to the exterior the blanched and 
whitened leaves, and it oftentimes happens that the blanched 
head most eagerly sought has been stripped sundry times, and 



114 ESS A YS AND ADDRESSES. 

while its surface is apparently fresh and crisp the centre is in 
a state of decay. Cabbage at certain seasons of the year will 
bear this process without rapid deterioration; but lettuce is 
much more perishable. Beets, radishes, and other roots which 
are offered for sale bunched, speedily deteriorate in moder- 
ately warm weather. This begins first at the circumference 
of the leaves, and actual decay at that part of the leaves and 
midribs compressed by tying, hence freshening is performed 
by clipping or tearing off the faded parts, and this process is 
repeated until the midrib is cut short to the crown, and then 
they are either bunched by the extremities of the roots or 
sold by measure, so that not infrequently the fresh beets 
upon our tables in May and June have been hauled from 
market to market for a week or more. Pease and beans are 
offered for sale bulked upon the market-stand, and the sales- 
man always measures from the bottom. The surplus from 
previous sale-days is heaped upon the stand, and the entire 
surface neatly and adroitly covered with a sufficient quantity 
of the more recently gathered. Great taste is displayed in 
making the stale surplus look attractive, and much tact is 
acquired in measuring so as to disturb the surface but little 
and secure for the purchaser the full measure of the under- 
lying deteriorated legumen. Spinach and kale, after the first 
rush of the season is over, are generally so cheap as to render 
the freshening process unremunerative; but when dear the 
latter is freshened by clipping or tearing off the faded parts 
of the leaves, reclipping the foot-stalks, and sprinkling. 
Spinach in cold weather can be preserved in a fair condition 
for some days. But did it ever occur to you that a crop 
which is left standing in the open ground during winter 
could not be gathered in such quantities as is sometimes 
offered in the markets during hard weather, when the sur- 
face of the ground is covered with a foot of snow for weeks 
and sometimes months ? The salesman will tell you the 
crop was protected with a layer of straw or thick brush, 
and by removing this it was easily gathered. And so far 



ESS A YS AND ADDRESSES. 115 

he tells the truth; but if you undertake to remove straw 
loosely spread upon the earth, and covered by six or twelve 
inches of frozen snow, you will soon learn it is far from an 
easy task. The truth is, the crop is gathered before the 
snow falls, kept in a cool, secure place, and retained fre- 
quently until the price rules high. 

" Unfortunately, dead plants (Chambers) do not stink early 
enough to disgust the nose; but yet every minute they are 
kept after their actual death — that is, after they have ceased 
to be capable of growth — renders them in some degree less 
digestible. Sometimes they are kept too long out of mere 
carelessness, sometimes from lack of sale, but sometimes also 
intentionally, to make them look better at table. For a long 
time I could not make out why London asparagus so often 
disagreed with people, till at last I caught a gardener cutting 
it twenty-four hours before it was wanted, and putting it in 
a damp, warm frame, ' to swell/ as he said. Cucumbers and 
broccoli are often spoiled in the same way. The vast wagons 
of cabbage that one sees coming into London at midnight are 
often the bearers of two or three days' cutting in small gar- 
dens, kept till a full load is accumulated for a single journey. 
Sprinkled with water they look well, but never regain their 
fresh character. They ferment in the stomach and produce 
flatulence." 

Strawberries, raspberries, and blackberries are offered for 
sale either in bulk or in pint or quart measures as trans- 
ported. If in bulk, the freshening process is executed in the 
same manner as other products offered for sale in like man- 
ner, by carefully concealing the stale and deteriorated surplus 
from previous days by a neatly arranged surface, covering 
with fresh fruit from the near gardens; and great care is exer- 
cised in properly placing each berry, so as to hide thoroughly 
the underlying fermenting mass. If in baskets, the top is 
dressed with fresh fruits and without loss of measure. A 
dealer can purchase a crate containing fifty quart-baskets of 
strawberries from a producer, empty them upon his stand. 



116 ESSAYS AND ADDRESSES. 

refill each basket by placing every berry, undersell the pro- 
ducer standing alongside, and make money. His baskets 
will be " heaping full," and each berry will present a bright, 
glossy, fresh surface to the purchaser, while the producer's 
lot will have sunk below the margins of his baskets, and 
the surface of the topmost layer of berries will have lost 
glossiness. Thus the baskets are freshened. 

I may be mistaken, but my casual observations lead me to 
the conjecture that ill-formed and defective fruit is fre- 
quently the result of imperfect and deficient fecundation; and 
I have sometimes thought we might apply certain phenomena, 
which are constantly occurring in the vegetable kingdom, to 
the study and elucidation of the cause of monstrosities in the 
animal. 

Certain conditions are essential to secure complete fecunda- 
tion of fruit- and grain-bearing plants — sunlight, a certain 
amount of warmth and humidity of the atmosphere, requisite 
moisture and fertility of the earth, and adaptation of the soil 
to the vegetable growth. Cold, dashing rains falling at inop- 
portune times, by washing to the ground, and continuous 
blasts of wind, by blowing away the pollen-granules, seri- 
ously interfere with perfect fecundation. For instance, I 
have seen two fields of wheat, each on opposite sides of the 
same road, or adjoining, with like exposure, and growing 
upon soil presenting no obvious differences, one yielding 
abundantly, the other but a scanty crop. The latter had 
been caught just at the stage of full bloom by a rain and 
wind storm ; the other escaped because it was either in ad- 
vance or behind its neighboring field in growth and develop- 
ment ; and, again, when I have seen one field yielding heads 
of wheat with a full, plump grain for each ovum, and an 
adjoining or other stalks in the same field, springing 
with other spears from the same root, yielding heads with 
light and shrivelled and absent grains, I have inferred that 
in the first fecundation was complete, in some incomplete, 
and in other germ-cells it failed entirely. In this suggestion 



ESSAYS AND ADDRESSES. 117 

I antagonize the accepted views of agriculturists, who so gen- 
erally attribute these defects and failures alone to atmospheric 
and climatic influences operating during the stages of devel- 
opment and ripening. 

Impregnation of the seed-bearing flower, or its equivalent 
organ, is absolutely necessary in all grain-bearing plants, or 
else the product will be a failure. When single spears of 
corn stand alone the ears never fill, because the pollen from 
the top-gallant fails to reach every germ-cell through the silk; 
and if two rows of corn, each of a distinct variety, be planted 
alongside, every ear will contain grains of both varieties more 
or less distinctly marked; but if from any cause any part of 
the silk of an incipient ear be destroyed previous to fecun- 
dation, no grains will be developed in the cells connecting 
with such injured silk; and imperfect impregnation will find 
many illustrations in the ill-formed and defectively devel- 
oped grains. 

All flowers are sexual, being furnished with the fertilizing 
or fertile organs, or bisexual, possessing both stamens and 
pistils, varying in number from a single stamen and pistil to 
any indefinite number of each. In all fruit-bearing plants 
complete fecundation is essential to the perfection of the seed; 
and, as it is a rule, with but few exceptions, that a full devel- 
opment of the sarcocarp is concurrent with complete maturity 
of the seed, it is manifest that the perfection of the latter, like 
the perfection of the seed, must depend upon proper fecunda- 
tion. The first dropping of young fruit, which, even after an 
abundant show of blossoms, sometimes extends to the whole 
orchard crop, is, says Watson, mainly due to the imperfec- 
tion or total failure of the fertilization, whether this arises 
from drought and glaring sunshine, from unseasonable cold, 
an inopportune storm, or from other less manifest causes : all 
such dropped fruit is seedless or germless. Again, as it will 
occasionally happen, a fruit grown among a number upon 
the same tree will be seedless, and invariably such a fruit 
will be deficient in development — if not ill-formed, certainly 



118 ESSA YS AND ADDRESSES. 

diminutive in size. Neither the encumber nor the cantaloupe 
will fructify under glass, except by the actual and artificial 
contact of the staminate with the pistillate flower, even though 
the requisite conditions of humidity, temperature, sunlight, 
adaptation of the soil, and vigorous growth may all be pres- 
ent. The plants are monoecious, aud the sexually distinct 
blossoms grow in near proximity, yet the crop will prove a 
signal failure unless artificial impregnation is carefully exe- 
cuted ; and this is true of all fruit-bearing plants unless the 
fruit-bearing blossom is bisexual. Hence it is evident that 
some condition which pertains exclusively to the open air 
is essential to complete fecundation in the monoecious and 
dioecious plants. 

The strawberry-plant presents itself in distinct staminate 
and pistillate varieties, and with bisexual flowers. If you 
destroy in irregular patches the pistils projecting in great 
numbers from the posterior surface of the ovum of a pistil- 
late variety, or in like mauner occlude the stile-tubes, each 
one of which communicates with a germ-cell, and leave the 
undisturbed pistils and stile-tubes in near proximity to a 
staminate flower, those parts of the fruit will fecundate and 
develop to maturity, whereas the parts connecting with the 
destroyed pistils or occluded stile-tubes will remain undevel- 
oped, and the fruit as a whole will be ill-shapen and de- 
formed. Most of our fruit-bearing trees have perfect bisexual 
blossoms, with more than one stamen and a number of pis- 
tils, hence, reasoning from analogy, I have reached the con- 
clusion that knotty, irregularly shapen, and defectively de- 
veloped apples, pears, peaches, and other fruits, result from 
defective and imperfect fecundation. 

If these suggestions and observations are entitled to con- 
sideration, and worthy of being classed as facts, surely I have 
established the proposition that defective development in fruits 
is in a measure due to imperfect fecundation. I shall not, at 
present, undertake to estimate their value in determining the 
nature and causes of the degenerative changes which speedily 



ESSAYS AND ADDRESSES. 119 

take place in fresh fruits, nor the effect of such imperfectly 
developed fruits when consumed as food. 

The final considerations relate exclusively to the remedy 
for the imposition practised in the sale of fresh vegetables and 
fruits. A system of competent inspection will undoubtedly 
accomplish much and correct many of the alleged abuses ; 
and not only must the plan be wisely regulated, but the 
officials must be persons skilled in the art of gathering and 
packing and in the transportation of perishable fruits and 
vegetables. No mere novice who has passed a lounging life 
in a city, absolutely ignorant of the essential qualities of 
fresh fruit and vegetables, too weak to resist temptation, and 
too timid to discharge fearlessly a disagreeable duty, would 
accomplish any good. To this must be added the right of 
confiscation. The enormity of the crime must be brought 
directly home to the practical and pecuniary necessities of the 
offender. The business of huckstering can be conducted in a 
proper manner with profit, and I would rather not believe 
that every man engaged in the business resorts to the tricks 
of the trade. 

But the most effectual means for the accomplishment of 
satisfactory results will be the establishment of free market- 
places for the accommodation of the producers. Afford ample 
opportunities for the utilization of the products of his labor, 
and cease compelling him to sink his scanty earnings in the 
enormous profits of middlemen. The perishable products of 
the farm are introduced into cities for immediate consump- 
tion, and every obstacle which obstructs the ready access of 
the consumer to the producer should be removed, and munici- 
palities should abandon such sources of revenue. Thus may 
value be enhanced to the producer and diminished to the con- 
sumer. Quality will be improved and health promoted. 



120 ESSAYS AND ADDRESSES. 



OBSTETRICS AND DISEASES OF WOMEN AND 
CHILDREN. 

address in obstetrics and diseases of women and 

children, delivered before the american 

medical association at philadelphia, 

june 8, 1876. 

Mr. President and Gentlemen : The written law of 
this Association limits this address to the discussion of the 
" advances and discoveries of the past year" in obstetric, 
gynecic, and pediatric medicine. 

However willing or competent I might be to fill the meas- 
ure of this requirement, the time allowed me would necessa- 
rily preclude a critical examination of all the contributions to 
this department. Nor would this be desirable, since many of 
them are mere novelties of little or no value or hasty promul- 
gations of immatured opinions and illogical conclusions. 

The recent literature of this department of medicine may, 
not inaptly, be compared to a sheaf containing many heads 
of wheat ; some with each capsule filled with a perfectly devel- 
oped, matured, and ripened grain, rich in the elements essen- 
tial to its production in kind. Other beads contain light and 
shrivelled grains, the yield of an impoverished or ill-cultivated 
soil, which, while not wholly valueless, yet nevertheless are far 
below the proper standard in weight and measure, not unfit for 
ordinary consumption, but unworthy of preservation, and pro- 
gressively degenerating by reproduction. Lastly, other heads 
there are with empty capsules, destitute of a single fecundated 
ovum, containing nothing but chaff, mere abortions ab initio. 
To winnow out the chaff would, perhaps, be but a work of 
time, intelligently and assiduously employed ; but to glean 
from the entire mass only the perfect grains and to estimate 
the value of each demand a degree of accuracy only to be 



ESSAYS AND ADDRESSES. 121 

acquired by great experience and an impartial judgment. 
Even more is required to determine correctly what are the 
" advances and discoveries" in these branches of medical 
science, for every such claim must be submitted to the ruth- 
less arbitrament of time and be verified by the repeated 
observations of skilled specialists. 

Obstetricians are proverbially slow either to seek or to 
accept new things. The maxim of Blundell even yet im- 
presses the medical mind, and the great master, though re- 
tired from active pursuits, is still, in spirit, present at every 
accouchement, sounding the tocsin of alarm, " meddlesome 
midwifery is bad ; " and this, while it inspires some with 
awe, lest by some inadvertence they transgress the canons 
prescribed by him and others of equal renown, has, fortu- 
nately for suffering women, encouraged others to seek, 
through careful study and more careful observation, in this 
devious path of scientific research, additional aids by which 
the sphere of active interference in the management of ab- 
normal labors may be extended, the suffering of parturition 
diminished, and its dangers averted. 

To this end Goodell has devised a method of utilizing 
power in the delivery of " head-last " labors with safety to 
both mother and child, by rendering effective, through con- 
joint, suprapubic propulsion and " movements of unremitting 
traction " on the foetal neck, the minimum of traction force. 
This mode of delivery necessarily depends on " the tensile 
strength of an infant's neck," and the operator must accept 
the alternative of " killing in the attempt to save, rather than 
of killing by cowardly inaction." The force employed should 
not exceed the minimum of power requisite for decollation. 
The spinal column may snap under a weight of 105 pounds, 
the soft parts yielding under a weight of 120 pounds. 

Duncan concludes, from his recent experiments upon the 
fresh cadavers of adult foeti, that the power admissible in 
extraction by the feet cannot safely exceed the force of 100 
pounds, which is adverse to podalic version in narrow pelves; 



1 22 ESS A YS AND ADDRESSES. 

but in original breech presentations and footlings the alterna- 
tive is not, as a rule, between podalic and forceps extraction, 
for the procedure relates exclusively to the completion of de- 
livery by traction on the neck of a foetus partially extruded. 
And surely, in view of the mortality of breech presentations, 
even in the practice of specialists of unrivalled dexterity, the 
ipse dixit of a bygone period should not deter the obstetri- 
cian from efforts to employ this power to the best mechanical 
advantage. The method of Goodell is an advance in the 
right direction, and the hope may be cherished that we may 
hereafter " approach a case of head-last labor with an assur- 
ance of success such as we never had before. " 

Not less valuable and original is the procedure of the late 
Dr. John S. Parry, in which the hand is employed " to flex 
the head when partially extended in all its presentations, to 
transform occipito-posterior into occipito-anterior positions, 
and to change presentations of the face with the chiu behind 
into those of the vertex with the occiput in front." These ma- 
nipulations, doubtless more easily demonstrated in the lecture- 
room than executed on the living subject, supply aids for the 
conversion of some abnormal labors into natural ones, facili- 
tate the application of the forceps in certain cases, and expe- 
dite delivery in difficult cases of craniotomy. Dr. Parry 
enjoins " absolute certainty of diagnosis/' only to be secured 
by the " introduction of the whole hand into the vagina" — 
a resource which should never be omitted in case of doubt. 
More recently Penrose has suggested a method of hastening 
delivery in mento-anterior positions of the face by establish- 
ing a force of artificial resistance to the posterior cheek of the 
foetus, whereby rotation of the chin is promoted. 

Dr. George Johnston's successful application of the forceps 
to cases of undilated but dilatable os uteri is a practical nega- 
tion of another of the traditional canons, and constitutes an 
epoch in the history of obstetrics. He adapts such interfer- 
ence to cases "of early rupture of the membranes " and escape 
of the " liquor amnii before dilatation of the os; " to cases 



ESSAYS AXD ADDRESSES. 123 

where the membranes are entire, and the head has descended 
on the cervix without the intervention of the bag of waters, 
" and expanding it, thereby pressing as injuriously upon it 
as if the liquor amnii had escaped f 3 to cases complicated with 
prolapse of the funis; and to cases of partial placenta prsevia. 
This operation is, perhaps, inadmissible in cases where the 
extent of dilatation has not reached two-fifths (one and five- 
eighths inches), but is an encouraging resource whether the 
head is above or within the brim or has descended into the 
cavity of the pelvis, and is not less illustrative of the life- 
saving power of the instrument than of its value in shorten- 
ing the duration of labor. But while thus the capacity of 
the forceps as a tractor is being extended, its double-lever 
power is being discarded. Only recently Duncan, in an 
elaborate essay which has been commended by Keiller, Mac- 
donald, Simpson, Young, Bruce, aud others, has, with his 
usual vigor and directness, portrayed the dangers of the 
" pendulum movement of the midwifery forceps/' and in- 
sisted that it, like other honored relics of the past, should be 
dismissed from service. 

The fact cannot escape your observation that these innova- 
tions, born of thoughtful study, have emanated from men of 
large experience and unsurpassed dexterity, who have been 
favored with unusual advantages and a sound and intuitive 
judgment. Such advantages do not come to every accoucheur, 
but all can emulate their example and profit by their triumphs. 

Among the mechanical aids recently devised, Dr. Poullet 
has projected an apparatus denominated " the serieeps," for 
which he claims advantages in certain cases of dystocia supe- 
rior to the " steel of Chamberlen." 

This new device is made of a seamless material, woven 
double, having the maximum of solidity. It consists, first, 
of a transverse band intended to be spread around the foetal 
head, its two extremities being connected by cords of silk laced 
through eyelets. These cords are loose when the band is being 
adjusted, and when drawn should close the transverse band 



1 24 ESSA YS AND ADDRESSES. 

around the cranial ovoid along its suboccipito-malar circle. 
Second, of four ribbons inserted along the entire inferior bor- 
der of this band, and united at the other extremities, two by 
two, forming two handles, by which traction is made. The 
apparatus is adjusted by means of three arms introduced be- 
tween the uterus and foetal head, superposed one upon the 
other, in the sheaths formed by the ribbons, and when car- 
ried up to the promontory of the sacrum are separated, the 
posterior branch remaining in position, and (i the other two 
by a movement of rotation are carried along the sides of the 
head until they meet in front above the arch of the pubis, 
when the cords are drawn, the mental " arms removed, and 
extraction begun by traction upon the ribbon handles. 

If the circle has been placed sufficiently high upon the 
ovoid, it grasps a zone of smaller diameters than the central, 
so that the material being inelastic when traction is made, " it 
cannot descend until the cranial ovoid is drawn before it." If 
carried up to the chin or neck of the child, the circle is closed 
and gentle traction upon the ribbon handles adjusts the band 
to the cranial ovoid. 

Dr. Poullet claims " that in all cases requiring energetic 
traction, particularly in the superior strait," this instru- 
ment will diminish the mortality of children while better 
protecting the soft parts of the mother, and insists that its 
superiority over the forceps consists in the inappreciable vol- 
ume added to the child's head ; its easy application to cases 
of long and painful labor ; the pliability of the ribbons, which 
free the soft parts from violent pressure ; the absence of local- 
ized compression of the brain and of any imprint upon the 
head ; its affording means of prehension without lateral 
pressure; the firmness of the grasp, which never slips; the 
increased range permitted to the movements of rotation ; and 
its harmlessness, however long permitted to remain in posi- 
tion, thus in all of its actions resembling " physiological 
labor." It is also more easily and certainly applied in the 
rare cases of decapitation, affords greater opportunity for the 



ESSAYS AND ADDRESSES, 125 

operation of perforation, and contributes valuable aid in evac- 
uating the cranial cavity after perforation. 

The inventor refers to Mauriceau's idea of a sort of sling 
or bandage, which was never applied; to Armaud's descrip- 
tion of a cap of thread to be adjusted to the head after decapi- 
tation; and to Mead's handle or golf of soft material, to be 
inserted with a whalebone between the chin and chest, which 
Smellie tried to use, but finally abandoned; and concludes his 
review with the assertion " that at the present day there 
exists no pliable means capable of taking hold of the head 
when engaged in the pelvis and of exercising upon it sufficient 
traction to complete labor." 

The merit and originality of this invention belong to an 
American physician. As long ago as 1851 Dr. John Evans, 
of Chicago, published a description of his " Obstetrical Ex- 
tractor," and he had previously reported in the Transactions 
of this Association for 1850 five cases in which he had suc- 
cessfully applied the apparatus. Subsequently, in 1852, he 
published another series of twelve cases, some of which were 
in consultation with Prof. N. S. Davis. 

Nor is this all. The descriptions of the two inventions — 
one in the English, the other in the French language — are so 
nearly identical that it is not easy to believe the latter could 
have been written without previous knowledge and examina- 
tion of the former ; yet the latter was submitted to the Sur- 
gical Society of Lyons and referred to a committee of distin- 
guished physicians as an original description of a new instru- 
ment. 

The genius of our French inventor has found further 
opportunity for development in an attempt to utilize and 
regulate mechanical traction, by adapting the principle of the 
" windlass or capstan " to extraction, thus substituting, it is 
claimed, ' i a sustained and graduated mechanical force for the 
irregular muscular efforts of the operator. " Dr. Poullet con- 
cedes the original idea to his compeer, Joulin, claiming only 
to have transferred the point of support from the perineum 



126 ESSAYS AND ADDRESSES. 

to the tuber ischii, which, he maintains, will bear the pressure 
of the traction force without injury. 

The inventor claims to have realized the following condi- 
tions: " True and uniformly sustained traction," by making 
the pelvis of the woman the point of support. 

Greater opportunity for making traction " in the various 
directions useful in the different stages of labor." 

Increased facility for the application of force without re- 
straining the movements and position of the lower limbs. 

Obtaining support from the ischii without pain and with- 
out interfering with the use of the cords or " forceps or de- 
livery by the hand." 

These conditions, the author claims, present advantages 
superior to Chassagny's apparatus, which derived its point 
of support from the knees; to Tarnier's " tackle and pul- 
ley," which has for its point of resistance a neighboring 
plank ; to Hamon's apparatus, which is supported by two 
crutches resting on the genito-crural folds of the patient ; to 
Pros' s invention, in which the point of resistance " was a 
wooden frame placed under the seat of the patient ;" or to 
Joulin's " aid-forceps," which rest upon the soft parts of the 
perineum. Its practical merits cannot, however, be estab- 
lished by its comparative advantages over all previous devices 
to multiply force. It is questionable whether such multipliers 
of force can be utilized in dragging a foetus through the bony 
channel without serious injury to both mother and child or 
be made a substitute for the traction and compression powers 
of the forceps. 

In such case the power driving the foetal head downward 
and the power dragging it forward through the pelvic cavity, 
together with the counter- force acting upon the ischial tuber- 
osities, would be expended upon the framework of the maternal 
passage, for the true pelvis would present, at its superior 
strait or within its cavity, the obstacle to delivery, and, at 
the same time, at the termini of the transverse and shortest 
diameter of the outlet, the points of counter-resistance would, 



ESSAYS AND ADDRESSES. 127 

necessarily, be always equal, and, though acting in opposite 
directions: — the first through the wedge-like power of the foetal 
head and the latter upon the tuber ischii, transmitted along 
the ischial rami — would be expended upon the pelvic syn- 
chondroses, perhaps not often disturbing these attachments, 
but certainly subjecting them to double the force required in 
forceps extraction. Hence, apart from the fact that auto- 
matic movements cannot intelligently supply the muscular 
power and manual dexterity of the skilled obstetrician, it 
seems essential that all traction force, by whatever mechan- 
ical instrument supplied, must be free from and independent 
of any counter-pressure upon the pelvis of the mother. 

The discussion on the employment of perchloride of iron 
in post-partum hemorrhage has vindicated its value as a styp- 
tic and established its efficacy in those emergencies in which 
all things else seem to fail; but the fact remains undisturbed 
that complete and persistent uterine contraction is the one 
thing which assures haemostasis. 

Closely allied to this subject is the operation of transfusion. 
The recent successful employment of milk by Prof. T. G. 
Thomas, while it presents nothing new either in surgical exe- 
cution or in the nature or preparation of the fluid employed, 
is yet in its mere success a contribution to science, and adds 
assurance of the ultimate acceptance of the procedure as an 
imperative recourse in needful cases. 

The transfusion of milk was first successfully accomplished 
by Hodder in 1850, in two or three cases of cholera-collapse. 
Previously, however, Donne had injected milk into the veins 
of dogs and rabbits without injury to the animals; and sub- 
sequently (1854) Herapath, following Richardson's previously 
suggested treatment of cholera-collapse " by the artificial pro- 
duction of peritoneal or cellular dropsy, n advocated injections 
of milk or of milk and water into the peritoneal cavity, cellular 
tissue, or venous system in similar conditions. Waggstaffe, 
in 1872, made two unsuccessful attempts — one with con- 
densed milk in a case of " extensive hemorrhage" following 



128 ESSA YS AND ADDRESSES. 

amputation of both legs below the knee, the other with con- 
densed milk and defibrinated blood ; and Howe's experiment 
with goat's milk, in 1874, in a case of tubercular disease, 
proved equally unavailing. 

As yet, the elevation of temperature, which is one of the 
most constant and perhaps the most important phenomenon 
following transfusion, has not been explained. In Wagg- 
staffe's case it rose 2.8° in three hours (taken in the vagina), 
and in Thomas's case it rose in one hour to 104°. This py- 
rexia has been attributed to an extra absorption of the pro- 
ducts of tissue-change ; to absorption of pus from the wound; 
to accumulation of blood in the portal system ; to the intro- 
duction of a different sort of blood or of a fluid differing in 
nature and density ; to the destruction of the constituents of 
the blood, and to molecular disturbance ; but none of these 
hypotheses has been adopted. 

Frese concluded from his experiments that the transfusion 
of a small quantity of blood would not produce an appreci- 
able amount of fever; but that a large quantity, if preceded 
by bleeding, was always succeeded by fever. Albert and 
Strieker transfused into healthy animals their own blood by 
letting it flow directly from the femoral artery into the fem- 
oral vein of the same side, and each time fever resulted. 
Billroth repeated these experiments, but failed to obtain the 
same results. Leibrecht concludes, from similar experiments 
recently repeated, that an elevation of temperature, repre- 
sented by 2° Centigrade, may result from the simple transfu- 
sion of blood, and fever, if occurring at all, will always occur 
within three hours after the completion of the operation. In 
Hutter's cases of arterial transfusion with defibrinated human 
blood, and in Ewald's cases with the defibrinated blood of per- 
sons suffering from bronchitis, fever ensued. Fever resulted 
in all of the cases of Hasse and Thurn, who employed defi- 
brinated lamb's blood. Kuster had no unpleasant symptoms 
with human defibrinated blood, but fever and other unpleasant 
phenomena in a case in which lamb's blood was used. Nicholas 



ESSAYS AND ADDRESSES. 129 

Duranty's experiments on animals with cooled blood were 
entirely satisfactory. The researches of Ponfick and Landois 
seem to have established the deleterious influences of the 
introduction of the blood of different species in producing 
disintegration of the red blood-corpuscles and setting free 
haemoglobin, which can only be eliminated by the kidneys. 
These facts, together with the additional observation of Lan- 
dois that copious transfusion produces massing of the blood- 
cells, which tends to extensive coagulation, and the more 
recent demonstration by Panum that an extra supply of red 
blood-corpuscles involves an additional consumption of oxy- 
gen, and that heat is evolved by their oxidation, may furnish 
the key by which this problem may be solved. 

These results, both clinical and experimental, seem to estab- 
lish the hsernic origin of the fever. Yet the not unusual 
occurrence of other phenomena denoting " disturbance of the 
functions of innervation and circulation;" the sudden and 
rapid ascent, and, in successful cases, the equally rapid de- 
scent of the temperature, suggest the probable co-operation 
of a neurotic element, to which attention has been recently 
directed by Dr. H. C. Wood, Jr. The doctrine is, however, 
not universally accepted that elevation of body-temperature 
and fever are synonymous. This source of error can only be 
eliminated by more thorough and carefully recorded clinical 
histories. 

The clinical and experimental observations, apart from the 
accidents incident to the formation of coagula ; the convey- 
ance of emboli into the general circulation; the introduction 
of air ; the too rapid repletion of the right side of the heart ; 
and the injurious effects upon the blood -mass, favor the con- 
clusion that the chief cause of failure and death lies in the 
febrile phenomena, which are, perhaps, proportionate to the 
amount of fluid transfused, enhanced by any pre-existing 
fever or previous hemorrhage, and the neglect of this febrile 
condition in the subsequent management of the case. Hence 
it is that the largest percentages of recoveries have been in 

9 



130 ESSAYS AND ADDRESSES. 

those cases in which there was a previous reduction of tem- 
perature and in those uncomplicated with pre-existing pyrexia 
or subsequent irritative fever, as in cases of surgical hemor- 
rhage. 

Defibrinated human blood and milk are not exposed to the 
pernicious effects pointed out by Ponfick and Landois. The 
introduction of the former is less likely to produce fever than 
milk; but the fever following the transfusion of milk is prob- 
ably unconnected with the setting free of haemoglobin, the 
consequent renal complication, and the resultant ursemic phe- 
nomena. 

In puerperal medicine there has been steady and commend- 
able progress. Thanks to Hewitt, Barker, Cairns, Goodell, 
and others equally eminent, puerperal convalescence has well- 
nigh ceased to be regarded as a season of punishment, of seclu- 
sion from sunlight and fresh air, and of starving penitence. 
The conventional charred bread, mean tea, and meaner slops — 
the unsavory products of shadows badly boiled — have been 
supplanted by a more generous, nutritious, and easily digested 
diet, thus contributing to the pleasures and comforts and les- 
sening the perils of the lying-in. 

The subject of puerperal fever continues to attract atten- 
tion; and notwithstanding the extensive and valuable re- 
searches in pathological anatomy, and especially in the study 
of the morbid lesions of the several diseases, which, unfortu- 
nately, have been too frequently comprehended under the 
generic term " puerperal fever," certain questions which con- 
stitute the essential basis of a definite and practical knowledge 
of its history and nature remain unsettled. The existence of 
an essential fever, peculiar to puerperal women, resulting from 
unknown blood-changes and unaccompanied by uniform and 
constant morbid lesions, is both affirmed and denied by men 
of acknowledged eminence. But recently Duncan, from a 
careful study and graphic analysis of the mortality-statistics 
of the city of London from 1848 to 1874 (both inclusive), has 
reached the conclusion that " puerperal fever or pyaemia " is 



ESSAYS AND ADDRESSES. 131 

absolutely free from epidemic prevalence, and that it has no 
causal relation whatsoever either with erysipelas or scarlet 
fever. Thus, on the very threshold of our studies we are 
confronted with antagonism of facts and deductions, and men 
of honest conviction find themselves arrayed in open contro- 
versy. 

The recognition of the morbid entities which are severally 
peculiar to puerperality, and their differentiation by distinct 
and characteristic symptoms, has extended and enlarged the 
resources of preventive and curative medicine; but the rela- 
tion of the lesions to the parturient womb remains obscured 
by the uncertainties of conjecture and hypothesis. It was 
long ago admitted that parturition, though a physiological 
process, was necessarily one of violence. Van Swieten and 
Willis, two centuries ago, and Eisenmann, in 1837, regarded 
puerperal fever as " wound-fever ; " then followed the theories 
of Cruveilhier, Simpson, and others, who traced its analogy 
to surgical fever ; then a further advance when phlebitis and 
lymphangitis were first recognized; then, again, a grander 
progress when the pysemic and septicemic processes were elu- 
cidated and the doctrines of thrombosis and embolism were 
promulgated by Virchow. To these have been added the 
investigations into the nature and intensity of septic poisons; 
the theory of parasitic disease ; and the researches of Sander- 
son " on the infective product of all acute suppurative inflam- 
mations. n Now all have come with Buhl, Virchow, Kolb, 
and others to regard the traumatism of the inner uterine sur- 
face, the unavoidable lesions of continuity in the generative 
tract, and thrombosis of uterine sinuses as foci of disease. 

The recent investigations of Leopold and Championniere 
into the histological anatomy of the lymphatics of the uterus 
and its appendages furnish additional opportunities for patho- 
logical research, and enable us to trace through continuous 
channels the extension and propagation of disease from the 
original foci and the infection of parts far removed from the 
primary seat. So numerous are the lymphatics of the uterus, 



132 ESS A YS AND ADDRESSES. 

and ramifying as they do throughout the parenchyma, the 
subserous tissue, and mucous lining, they cannot be omitted 
from the study of the life and pathology of the organ. " In 
gravid uterus," says Cruikshank, " the trunks of the hypo- 
gastric absorbents are as large as a goose-quill, and the ves- 
sels themselves so numerous that when injected with quick- 
silver one would have been almost tempted to suppose the 
uterus consisted of absorbents only." 

In view of the importance of these recent researches I may 
be pardoned for quoting the following summary of the results 
of Leopold's investigations: 

" The lymphatics of the mucous membrane consist of 
lymph-spaces, representing the interstices of the minute con- 
nective-tissue framework, along the bundles of which are 
endothelia. The membrane of the glands is, in the deeper 
layers, a fine layer of delicate connective-tissue bundles, whose 
endothelia are applied externally; nearer the surface it is a 
sheath, composed only of " platiform cells." The bloodves- 
sels, from the finest capillaries, possess a number of fine endo- 
thelial sheaths. The connective-tissue framework stands in 
direct communication with both kinds of sheaths ; therefore, 
both glands and bloodvessels pass directly through the lymph- 
cavities, separated from the latter only by their endothelial 
sheaths formed of the connective-tissue trabecular At the 
boundary of the muscular layer the lymph-spaces pass for a 
short distance, deeper in woman than in animals, into the 
funnel-shaped excavations between the muscle-bundles, and 
gradually narrow down to the intermuscular lymph- vessels 
and tracks. 

" The muscularis contains both lymph-vessels and spaces, 
the walls of which are the fine intermuscular connective tis- 
sue. The former are lined by fine endothelial lamellae, pre- 
senting openings and gaps here and there; the latter are lined 
by delicate cell-plates. In the human uterus the lymph- vessels 
are very much entangled by the peculiar arrangement of the 
muscularis ; they are most commonly abundantly developed 



ESSAYS AND ADDRESSES. 133 

in the external layer and in the other layers, especially in 
the vicinity of the larger bloodvessels, and, as in animals, 
in connection with the siibserosa; with the mucosa the con- 
nection is more by lymph-spaces. They collect in the exter- 
nal layer, especially at the sides of the uterus, in the form of 
large collecting-tubes which possess valves. The lymph- 
spaces are webbed around the fasciculi of the larger muscle- 
bundles and pass into the lymph-vessels, and in woman are 
in direct communication with the spaces of the mucous mem- 
brane. The larger collecting-tubes and larger bloodvessels 
are in immediate proximity ; the other lymph-vessels, for 
certain distances, are accompanied by bloodvessels, and the 
lymph-spaces and fissures are always traversed by smaller 
vessels. 

" Beneath the serosa only lymph -vessels are found lying 
in the connective tissue and forming large, entangled, tense 
networks, possessing large ampullae, radiating points, con- 
strictions, valves, contractions, and dilatations, and like a 
network enclose the entire uterus, forming upon the anterior 
and posterior surfaces a number of small, minutely twisted 
nets, with thin and thick canals, and numberless ramifica- 
tions with branches, which, during pregnancy, may be dem- 
onstrated as far as and into the fimbriae of the tubes, and 
other branches communicating, where the serosa is firmly 
adherent to the uterus, with the subjacent lymphatics of the 
muscularis, while the superficial vessels of the loosely at- 
tached serosa enter directly into the larger lymph-tubes ; so 
that from the periphery of the uterus the lymph-current is 
through the muscular vessels to the tubes of the parame- 
trium, while from the sparse vessels it is direct to the trunks. 

" From the lymph-spaces of the mucous membrane the 
lymph passes through the mucous-membrane funnels into the 
lymph-fissures and vessels of the muscularis, is here webbed 
around all bundles and fasciculi as far as the serosa, and then 
unite from all sides in the large collecting-trunks, which, in 
the vicinity of large bloodvessels, enter the ligaments latse." 



134 ESSA YS AND ADDRESSES. 

Championniere has shown the existence of networks of 
lymphatics above the lateral vaginal cul-de-sac and in the 
lax cellular tissue which environs the neck, and has also 
shown the existence of vessels, remarkable for their number 
and dimensions, climbing up alongside of the uterus and 
reaching the broad ligament. He has further pointed out 
the arrangement of the lymphatics in the uterine tissue and 
broad ligaments in ampullae, upon the walls of which numer- 
ous smaller vessels open, and which sometimes are dilated 
into purulent cavities. He especially insists upon the inti- 
mate relation of the uterine lymphatics with the peritoneum; 
the annexes; with the cellular tissue on the lateral portions 
of the neck, the body, the iliac fossae, and the lumbar region. 
He has shown the presence of glands in the vicinity of the 
neck and ou the side and behind it ; above the lateral vagi- 
nal culs-de-sac ; in the broad ligaments ; at the level of the 
superior strait, and in the surrounding tissues as far as the 
periphery of the pelvis. Those above the lateral culs-de-sac 
extend in a chain of small glands to the lateral walls of the 
pelvis. In those at the level of the superior strait certain 
uterine lymphatics empty, and from them vessels ascend upon 
the psoas muscle and reach the glands on the side of the ver- 
tebral column and in the lumbar region. 

It is, however, impossible to study the anatomy of the 
lymphatic system of the uterus and its appendages completely 
without occupying one's self with pathology, " which fur- 
nishes veritable methods" of demonstration. Since the time 
of Cruveilhier lymph-vessel inflammation has been looked 
upon as a frequent accompaniment of puerperal diseases ; but 
not until Virchow promulgated the doctrine of lymph-throm- 
bosis did pathology advance beyond the view that inflamma- 
tion of the vessels was either a constant or necessary part of 
the morbid changes, and that the extension and propagation 
of disease were by continuity of surface or by contiguity of 
affected parts, or by some occult metastatic process. Even 
previously attention had been (Hecker, Buhl) directed to the 



ESSAYS AND ADDRESSES. 135 

condition, in which lymph-vessels, distant from the uterus, 
had been dilated and filled with firm or fluid masses, some- 
times puriform. Cruveilhier had described ampulla-like dila- 
tations and others as simple sacs united in a bead-like manner, 
filled with " yellowish-white and firm, pulpy, or creamy con- 
tents." These conditions had been most frequently found in 
the broad ligaments; in the neighborhood of the insertion of 
the tubes ; along the lateral portions (Virchow) of the uterus; 
or, ascending along the internal spermatic vessels, could be 
traced to the lumbar glands. They have also beeu found in 
the walls of the uterine body and cervix, and especially in the 
ovaries (Virchow), which are sometimes " so densely traversed 
by these filled-up and dilated lymph-vessels, that with every 
section a number of yellow plugs or cords " are exposed to 
view. This condition Virchow has denominated thrombosis. 
He denies that the contents of such lymph-vessels are an exu- 
dation, but concedes that inflammation of the coats of the 
vessels may follow, and the thrombus may undergo puriform 
disintegration. Inasmuch as normal lymph is but partially, 
if at all, capable of coagulation, except when extravasated 
or exposed to air, the formation of thrombi must be accepted 
as the evidence of some chemical or pathological change in its 
constitution, produced by contamination with peccant mate- 
rial absorbed from the original foci of disease; and hence 
when present must be considered in its relation to such pri- 
mary disease. Thrombi may arrest the current of poisoned 
lymph, become a barrier to the further extension of dis- 
ease, and thus localize the pathological process. They may 
become the starting-points of a new infection, for " phleg- 
monous foci," or collections of poisoned lymph, either fluid 
or in masses, or impenetrable glands undergoing puriform 
degeneration may and frequently do become centres from 
which spread infection to other and distant parts. In fact, 
Virchow insists that lymph-thrombosis is only associated 
with the graver forms of puerperal metritis and parametritis, 
and is in itself the manifest evidence of intense infection. 



136 ESSAYS AND ADDRESSES. 

Now, when we have come to regard the intertrabecular 
meshes of the cellular tissue as intercommunicating lymph- 
spaces and the pleural and peritoneal cavities as expanded 
lymph-sacs, with numerous stomata opening upon their surfaces 
and communicating with the lymph- vessels and spaces under- 
lying their endothelial lining ; and to know that the uterus is 
abundantly supplied with lymph -tracks, perivascular spaces, 
and vessels ramifying through its tissue and connecting with 
efferent trunks, through which there is an unobstructed current, 
and which are enlarged by the gravid process, is it any mar- 
vel that noxious material having its origin in circumscribed 
necrosis of uterine tissue, or introduced from without through 
fissures, rents, lacerations, or any trivial lesion, should be 
transmitted along the lymph-current, conveyed into the 
blood-vascular system, and thus become disseminated through- 
out the general system? That disease may be conveyed 
through the lymph-current is illustrated by following the 
course of bacteria through the body. Heiberg has traced 
these micro-organisms from the original colonies on the inner 
uterine surface of puerperal women into the larger lymph- 
spaces ; the lymph-cells ; the deeper uterine tissues ; the 
lymphatic glands ; the sinuses of the retroperitoneal glands, 
and into smaller abscesses of the lungs ; and others have 
found them in the heart, in metastatic deposits in various 
organs, and in the renal tubules. It is immaterial, in this 
connection, whether these organisms be carriers of disease or 
accidental phenomena attending its development ; their pres- 
ence in localities remote from the original colony and in the 
course of the lymph -current must be accepted as corrobora- 
tive evidence of the transmission of the materies morbi through 
the lymph-channels. 

The literature of medicine supplies numerous facts illus- 
trating the role which the lymphatics play in the pathology of 
puerperal diseases. Cruveilhier has presented illustratious of 
networks of distended lymphatics covering the womb. Botrel 
has traced dilated lymph-vessels extending from diseased 



ESSAYS AND ADDRESSES. 137 

parts of the womb to the broad ligaments and to the peri- 
toneum. Championniere has connected lymphangitis with 
laceration of the os internum. Duplay found the inguinal 
glands infiltrated with pus, and Quinquard found them 
swollen in a case of puerperal lymphangitis. In another 
case the latter found " a lumbar gland as large as a small 
apple and approached by several voluminous afferent vessels 
filled with pus." Bernutz refers to two cases of pelvi-peri- 
tonitis supervening upon cervical chancre, and admits that 
the inguinal glands are involved in almost every case of cer- 
vical chancre; nor does he deny " the possibility of uterine 
chancre reacting upon the lumbar ganglia." He cites a 
number of cases showing the connection which exists between 
inflammation and ulceration of the uterine mucosa and peri- 
tonitis, but does not admit the propagation of the disease to 
the peritoneum through lymph-channels or its extension from 
intrapelvic lymphitis. Mme. Boivin and A. Duges not infre- 
quently observed, in cases of puerperal metritis, the lymph- 
atics through the entire " length of the broad ligament dis- 
tended with white, lactiform pus," and occasionally the lumbar 
glands whitened with similar fluid. They refer to the report 
of the thirty-six autopsies (Journ. Complementaire, vol. xl. p. 
97) in which pus was found in the absorbents. In twenty- 
nine of these a purulent effusion was found in the peritoneal 
cavity, and they controvert the assumption that the pus was 
the product of a morbid process involving the texture of the 
lymph-vessels. Parry found, in cases of puerperal fever 
characterized by diphtheritic deposits on the wounds of the 
genital passages, the lymphatics of the broad ligaments, and 
occasionally those ramifying over the lower portion of the 
body of the uterus, occluded by thrombi ; and in one case in 
which the " vagina and endometrium were covered with 
diphtheritic membrane" he found the external surface of 
the uterus enclosed with a " beautiful reticulum of lymphatic 
vessels, some dilated almost to the size of a crow's quill. In 
some the dilatation was uniform; in others the vessel was 



138 ESSAYS AND ADDRESSES. 

studded with a series of varicose enlargements which might 
be compared to a string of beads, and which varied in size 
from a millet-seed to that of a pea/' and contained a pus-like 
fluid. In every fatal case of this peculiar form of puerperal 
fever pelvic cellulitis was present. Tonele records {Bovin 
and Duges, p. 330) a case of puerperal metritis in which the 
lymphatics of the abdomen were distended and of a milky 
color; the thoracic duct was enlarged and filled with pus ; 
and a large quantity of puriform fluid was fouud in the peri- 
toneal cavity. Gallard reports the case of a woman who died 
of puerperal fever twenty days after delivery, in which he 
found under the uterine mucosa minute abscesses containing 
yellow, creamy pus. In the case of a woman from whose knee 
Mr. Hawkins had removed a " sloughing bursa' 7 a few days 
previous to her confinement, and who died from fever which 
set in a few days after the operatiou, the lymphatics of the 
broad ligaments were gorged with pus. Broca applied the 
actual cautery to an ulcer of the cervix uteri in a woman three 
months advanced in pregnancy, and she died in a few days. 
In this case, besides the general peritonitis, the lymphatics 
on each side of the womb, which were traced to the ulcer, 
were filled with pus. D'Espine reports the case of two 
women who died after an operation on the pudenda, in 
which the pelvic lymphatics were distended with pus; and 
in a case in which death followed the removal of a chancroid 
from the cervix uteri, Buhl found the lymphatics alongside 
of the womb filled with pus. Championniere found the lymph- 
glands alongside of the womb enlarged and red, and in the 
cavity of the body pieces of putrid placenta. Guerin has re- 
cently reported two cases of periuterine lymphadenitis follow- 
ing delivery; and D'Espine found the lymph-vessels filled 
with a fetid fluid similar to that found in the cavity of the 
womb, in which were bits of putrid placenta. These illus- 
trations demonstrate the anatomical distribution and connec- 
tions of the uterine system of lymph-channels and exemplify 
the facility with which morbid conditions and ichorrhsemic 



ESSAYS AND ADDRESSES. 139 

fluids may be transmitted from the original foci of disease 
located in the uterine tissues to other and remote parts 
through the lymphatic apparatus. 

The pathology of puerperal eclampsia continues so involved 
by the confusion of conflicting opinions that the student is 
worse confounded than were the builders at the Tower of 
Babel. But notwithstanding this diversity and contrariety 
of opinion, there are a few facts which may be profitably 
studied in connection with recent discoveries. 

First. About 90 per cent, of the cases of puerperal eclamp- 
sia are associated with albuminuria. 

Second. Much larger number of the autopsies of women 
dying of puerperal convulsions exhibit renal lesion; and 
Bright's disease in women is most frequently among the 
childbearing and during the childbearing period. Hence the 
corollary is inevitable, that pregnancy stands in the relation 
of cause. 

To this, however, there is an apparent contradiction, in 
that prirniparse and plural pregnancies are more liable to 
convulsions than multiparas, whereas by parity of reasoning 
the reverse should be obtained. 

The excess of liability in the primiparaB and plural preg- 
nancies, and the additional fact that depletion of the gravid 
womb is the most certain method of terminating the convul- 
sive attacks, has given undue prominence to the mechanical 
theory of causation — i. e., obstructive hyperemia of the kid- 
neys. I acknowledge the force of this hypothesis, but can- 
not accept its absolute verity. That a kidney engorged, either 
with arterial or venous blood, should yield a diminished quan- 
tity of urine, and that it should be stained with blood and 
contain albumin, either or both is not remarkable; nor is it 
extraordinary that such a condition should result in the pro- 
duction of lesions similar to if not identical with the ordi- 
nary post-mortem appearances found in cases of Bright's 
disease. But it is the presence of the gravid womb, not of 
every abdominal tumor, which is so frequently associated 



140 ESSAYS AND ADDRESSES. 

with albuminuria. Nor is this phenomenon only incident to 
the period of greatest mechanical disturbance, but to the con- 
dition of gravidity, and oftentimes is present long anterior 
to the commencement of convulsions or to the completion of 
the term. It is but a symptom denoting a chauge in the 
blood-pressure, either in the renal vessels (Wagner), or in 
those of the whole body, or alterations in the parenchyma of 
the kidneys, or true disease of the renal substance, or, per- 
haps more frequently, an altered coudition of the blood. If, 
then, interruption of the blood-current through the emulgent 
veins be a factor, it must, like many of the accidental phe- 
nomena of utero-gestation, be classed as an adjuvant — the 
culminating event — and as such offers an explanation of the 
greater frequency of convulsions among the primiparse, be- 
cause of the greater tension and rigidity of the abdominal 
walls and the unaltered relations of the angle of pelvic incli- 
nation. Pregnancy, not the period of utero-gestation, is the 
essential factor. The cause, then, must lie in the altered re- 
lation, not of the parts which lie in anatomical contiguity, 
but of the functions of the animal economy. 

During pregnancy the mass of blood (which increases with 
the wants of the foetus) is augmented ; its constituent fibrin is 
increased ; the albumin is diminished ; the number of red 
blood-corpuscles is reduced (most markedly so during the 
later months); its temperature is elevated ; there is a dispo- 
sition to venous stasis, general or affecting particular vas- 
cular regions or systems ; the proportions of solids lessen 
and the quantity of water increases with the progress of ges- 
tation ; the normal relation which exists between the fibrin 
and water is disturbed ; there is hypertrophy of the left ven- 
tricle; the heart becomes more vigorous; arterial tension, 
especially in the primiparse, is increased, and during labor 
the blood-pressure, both arterial and venous (Fritsch), rises 
while a uterine contraction is present. Thus, conditions 
favoring fibrin-separation and congestions are present to a 



ESSAYS AND ADDRESSES. 141 

remarkable degree, and various viscera — brain, heart, lungs, 
and kidneys — may be congested. There are also added and 
retained effete products of the blood, and as a consequence 
increased strain upon the kidneys. In the primiparse the 
vascular apparatus (F. Barnes) is not adapted, and in many 
pregnant women the assimilation of nutriment is inadequate 
to the added physiological work; and the tension of the cere- 
bral vessels, which increases with the progress of gestation, 
attains its maximum during parturition when convulsions 
most frequently occur. There are, in addition, an increase of 
nerve-force, irritation of the pneumogastric, and a nervous 
sensitiveness especially characteristic of pregnancy. 

The evacuation of the gravid uterus is followed by engorge- 
ment of the abdominal veins, which had been more or less 
obstructed by the pressure of the enlarged organ. This 
abstraction of blood from the thoracic organs and from the 
brain, harmless as it is in most cases of parturition and salu- 
tary as it proves to be in a majority of cases of convulsions, 
may result in such a condition of cerebral anaemia, enfeebled 
and irregular cardiac action, and decarbonization of the blood 
as to become, in conjunction with the deteriorated condition 
of the blood-mass, the immediate and exciting cause of post- 
partum convulsions. 

The condition of the blood during pregnancy simulates 
ansemia, which is aggravated by the loss of albumin; yet the 
condition of the system is that of physiological plethora, due 
to the increment of the blood-mass. During pregnancy and 
during labor the brain may contain a redundancy of this im- 
poverished and deteriorated blood, and yet be insufficiently 
nourished. The sudden engorgement of the abdominal veins 
after delivery may withdraw from the brain the requisite 
amount of fluid. In both instances the brain is anaeinic — in 
one case containing an excess, in the other a deficiency of the 
altered and toxsemic blood. Landois claims that venous hyper- 
emia of the medulla will occasion epileptiform convulsions; 



142 ESSAYS AND ADDRESSES. 

and Hermann and Escher (Wagner) have shown by experi- 
mentation that such convulsions may result from either a 
diminished or increased supply of blood to the brain. 

To these physiological departures from a condition of 
health, due to the pregnant state and taking place coinci- 
dent!^ in the blood, the vascular apparatus and the nervous 
centres, most rapid in their progressive development and 
manifest in their effects upon the animal economy during the 
period when puerperal convulsions usually occur, and to the 
consecutive and consequent morbid changes, we must look for 
the predisposing and proximate causes of puerperal eclampsia. 
It is, however, my purpose at present to associate these con- 
ditions with other facts which have but recently come to our 
knowledge. 

The physiological phenomena which favor cerebral conges- 
tion lend force to the once very commonly accepted theory 
that puerperal convulsions were occasioned by a determina- 
tion of blood to the head. This view derives important cor- 
roboration from the anatomical resemblance of the arterial 
cerebral circulation in women and in the cow, to which par- 
turient apoplexy and convulsions are mainly confined. The 
points of resemblance, as indicated by Prof. Walley, are in 
connection with the distribution of the internal carotids and 
the formation of the basilar artery and the circle of Willis, 
which favor a larger and more direct supply of blood to the 
brain, especially to the medulla oblongata and pons Varolii — 
the centres from which emanate the convulsive action in puer- 
peral eclampsia. If these researches should be confirmed by 
future investigations, we have present during pregnancy a 
condition of the blood, increased arterial tension, augmented 
blood-pressure, and an anatomical arrangement of the brain 
vascular apparatus — which favor intracranial congestion. To 
these may be added toxaemia from destruction of the red blood- 
corpuscles and retained effete products from renal congestion; 
malnutrition from the loss and comsumption of albumin and 
from inadequate supply of nutriment; deficient consumption 



ESSAYS AND ADDRESSES. 143 

of oxvs;en from diminution of muscular action; and the 
various incidental nervous phenomena which so frequently 
complicate the period of utero-gestation. All these, acting 
together in the turbulent union of untoward events, culminate 
in convulsions. 

But perhaps the most important contribution recently made 
to the study of the nature of puerperal eclampsia consists in 
the recognition of the febrile phenomena so uniformly asso- 
ciated with the convulsive seizures. 

Quincke was the first to observe the elevation of tempera- 
ture in puerperal eclampsia ; but to Bourneville we are in- 
debted for the first series of systematic observations. From 
carefully recorded thermometric observations in seventeen 
cases, including four fatal cases, he deduces the following 
conclusions: 

1. " During the eclampsic state the temperature is raised 
from the outset of the attack to its termination. 

2. " In the intervals of the attacks the temperature re- 
mains elevated, and, at the moment of the convulsions, a 
slight ascension takes place. 

3. "If the eclampsic condition is about to terminate in 
death, the temperature continues to augment and reaches a 
very elevated figure; if, on the contrary, the attacks diminish 
and the coma ceases in a definite manner, the temperature 
lowers progressively and returns to the normal standard. " 

In June, 1875, M. Dieude published four new observa- 
tions, two of which confirmed the opinions of Bourneville; 
the others invalidated in part the proposition that the tem- 
perature was elevated in eclampsia, and incidentally the 
proposition that in the intervals it was maintained at a high 
degree and slightly elevated at the time of the convulsions. 
In December last Herbart published three additional cases ; 
a single observation has been made by Richardson and two 
by myself, making in all twenty-seven cases. With the ex- 
ception of the two cases, before referred to, the observations 
confirmed the conclusions deduced by Bourneville ; of these 



144 ESSAYS AND ADDRESSES. 

twenty-five cases seven died. A single death occurred with 
a temperature as low as 102.4° F.; in the other six cases the 
highest elevations ranged from 104° to 109.5° F. Among 
the recoveries the temperature rose in one case to 105.8°, and 
in another to 106°. Therefore, the maximum of safety can- 
not be established ; but in all the fatal cases the temperature 
remained elevated, and, when lessened, recovery followed. 
No death occurred with a temperature below 102.4°, and no 
recovery took place with a temperature above 106°. The 
thermometric curve was not uniform, because of the altera- 
tions produced by the effect of the therapeutic agents. 

These results present important indications in regard to the 
treatment and prognosis in cases of puerperal eclampsia. The 
value of remedies may be determined by the modifications of 
the temperature, and their inutility may be established by its 
progressive elevation. The fever, be it a factor of causation 
or a coincident phenomenon of the convulsive environment, 
is manifestly an element of danger. This inference is cor- 
roborated by the varying successes of the different therapeutic 
agents which have from time to time been employed in the 
treatment, and which owe their efficacy to their antipyretic 
qualities, or rather to their power to abstract body-heat. 
Venesection, which at one time was regarded as the u sheet- 
anchor" of hope and even now has many advocates, not only 
diminishes the mass of blood, lessens arterial tension, and re- 
lieves blood-pressure, but produces rapid falling of the tem- 
perature in the well as in the sick. This effect may be tran- 
sitory and speedily followed by increased arterial tension and 
an elevation of temperature, but the fever-curve of eclampsia 
exhibits marked depression , after the abstraction of blood. 
In Richardson's case the temperature fell from 103 F. ° to 
102° after venesection, but the tenseness of the jugular veins 
and unconsciousness continuing a second abstraction of blood, 
with the application of an iced collar to the neck, established 
convalescence. In Herbart's case the abstraction of twenty 
ounces of blood was followed by an immediate fall of 1°, and 



ESSAYS AXJD ADDBESSES. 145 

in the five succeeding hours of 3.5°. The illustrations might 
be multiplied ; and even in the fatal cases venesection when 
employed, either for a time stayed the progressive elevation 
or depressed the temperature, to rise again. 

Chloroform narcosis lowers body-heat by diminishing the 
rapidity (Billroth) of metamorphosis, thus lessening the pro- 
duction of heat. Chloral hydrate lessens heart-action and 
lowers temperature. In the fever of eclampsia the effect of 
both of these ascents is marked by the descent of the curve. 
Yeratrum viride, so highly extolled by Hearn, depresses the 
temperature, slows the heart, lessens arterial tension, and 
diminishes blood-pressure. Digitalis diminishes the activity 
of heat-production. Aconite depresses the body-heat " by 
its paralyzing action on the heart and organs of circulation." 
Cold affusions, purgation, and nauseants lessen body-heat. In 
brief, the successful methods of treatment of puerperal con- 
vulsions illustrate the " principle of physiological antagonism 
of therapeutic agents to the febrile state." I may add the 
evacuation of the gravid womb in its physiological influences 
diminishes the temperature. Xature indicates her resources 
in expediting the depletion of the uterus in very many cases 
of puerperal eclampsia ; and it is a fact that in a majority of 
cases the convulsions cease or diminish in frequency and 
intensity, with a marked reduction of temperature immedi- 
ately upon the completion of delivery. 

I will advance a step further and submit the proposition 
that the various methods of preventive treatment mainly 
owe their efficacy to their effect upon the blood and blood- 
vascular apparatus. As a rule, these are directed to the pro- 
motion of nutrition, whereby the loss of albumin is replen- 
ished, and to the relief of the hydremic condition of the 
blood by catharsis, diuresis, or diaphoresis. Heretofore the 
explanation of these excretory operations has rested for the 
most part upon the theory of eliminating the excrementitial 
and toxic elements accumulated in the blood. Xot less im- 
portant is the simultaneous effect in restoring the relation of 

10 



146 ESSAYS AND ADDRESSES. 

the solid and fluid parts, relieving arterial tension and dimin- 
ishing blood-pressure. The phenomena and consequences 
(Waguer) of diminution of albumin are disturbances of the 
endosmotic and exosmotic properties of the blood, " insuffi- 
cient formation of digestive fluids," altered nutrition, and 
repair of tissues, inanition, and albuminuria. 

Time will not permit me even to enumerate the almost 
numberless new suggestions with which the literature of 
gynecic medicine has been embellished during the past year. 

In a branch of medicine so rich in its opportunities for 
physiological and practical research it would indeed be strange 
if a single year should pass without substantial contributions 
being made to our knowledge, yet it cannot be said that in 
this extended field of inquiry a single disputed question has 
been finally and conclusively settled during the period we are 
reviewing. Accepted theories have been disputed; old doc- 
trines have been controverted ; established methods of treat- 
ment have been revised and new ones instituted; and addi- 
tional aids to diagnosis have been discovered. Research seems 
rioting in chaotic controversy, and the maxims of the masters 
are, one by one, disappearing before the innovations of the 
student. We seem as if standing in the dawn of a coming 
epoch when the results of these inquiries will be realized and 
conclusions will be reached freed from theory and individual 
bias and based upon undisputed physiological and pathologi- 
cal data. Then, and not till then, broad and comprehensive 
principles will take the place of individual observation and 
personal experience, and the practitioner will merge the ex- 
perimentalist in the student. 

The deficiency of gynecic medicine in accepted data suffi- 
cient to establish definite opinions has been illustrated in the 
recent discussions concerning the nature of menstruation and 
its relation to ovulation. Men of undoubted ability and im- 
partial judgment differ in regard to the condition of the 
uterine mucosa before, during, and subsequent to the peri- 
odic discharge of blood and in the significance of the observed 



ESSAYS AND ADDRESSES. 147 

phenomena. One, at least, has ventured to deny the physio- 
logical nature of menstruation and essayed to do away with the 
entire basis of physiological investigation by insisting that it is 
a pathological process which must find its prevention in im- 
pregnation during one of the pre-menstrual ovulatory periods 
and the quick and successive repetitiou of impregnation until 
the climacteric period shall have passed. While such con- 
clusions are maintained it is not strange that the therapeutical 
management of menstrual diseases should vary according as 
the practitioner accepts the results of oue or of another in- 
vestigator, and many must stray far away from a rational and 
philosophical basis of medication. Each will eagerly grasp 
the opportunities for treatment presented by the views he 
accepts. But recently Atthill, who regards the menstrual 
flow "as a discharge mainly composed of effete materials," 
has essayed to adapt the therapeutical management of amen- 
orrhoea and menorrhagia to the view that during menstrua- 
tion the entire mucosa is cast off, by suggesting that in certain 
forms of amenorrhoea the application of " agents calculated 
to hasten and bring about disintegration " and desquamation 
of the uteriue mucosa should be made immediately preceding 
the expected occurrence of the flow, and in cases of menor- 
rhagia a few days subsequent to the termination of the cata- 
menial period. 

So, likewise, have the sudden revolutions in methods of 
treatment been exemplified in the management of uterine 
fibroids. But a year ago the utility of ergot seemed almost 
established, and now all medication is threatened supersedure 
by surgical processes ; aud this is not surprising in view of 
the success of Greeuhalgh with the actual cautery in the enu- 
cleation of uterine fibroids; of Emmet in removal by traction ; 
of Kidd by dilatation of the uterus with numerous pieces of 
sea-tangle and subsequent removal by means of the ecraseur ; 
and of the operation of gastro-hysterectomy. These "ad- 
vances " in treatment are the logical results of the greater 
accuracy attained in diagnosis, by which uterine fibroids have 



148 ESS A YS AND AD DRESSES. 

been classed according to their amenability to medical or sur- 
gical treatment; and though a greater number of cases have 
been relegated to surgery, a larger proportion of cases have 
been rescued from the class hitherto regarded as incurable. 
Then, too, medicine is threatening to snatch from the domain 
of surgery its highest operation in gynecic medicine by the 
substitution of electrolysis for ovariotomy. So successful has 
this method proved in the practice of Dr. Semeleder that I 
hesitate to accept his statement, and am startled at the thought 
that the greatest triumph of modern surgery is to be super- 
seded by a process so simple and so painless. 



MEDICAL DEPAKTMENT OF THE UNIVERSITY 
OF GEORGETOWN. 

ADDRESS DELIVERED AT THE TWENTY-EIGHTH ANNUAL 

COMMENCEMENT OF THE MEDICAL DEPARTMENT 

OF THE UNIVERSITY OF GEORGETOWN, 

MARCH 19, 1877. 

Mr. President and Ladies and Gentlemen. Gen- 
tlemen of the Graduating Class : I congratulate you 
upon your elevation to the doctorate of medicine, and wel- 
come you to the brotherhood of the medical profession. 

With the termination of these exercises our relations as 
teacher and pupil end. No grief should embitter this sepa- 
ration; no sorrow mar these nuptial ceremonies. Here, in 
the presence of this splendid galaxy of beauty and loveliness, 
of friends and companions, assembled as guests and witnesses, 
where every face is radiant with joy and every tongue awaits 
the opportunity to bid you success and happiness, you have 
assumed newer and higher duties, other and graver responsi- 
bilities, and now your alma mater bids me deliver to you her 
final admonition. 



ESSAYS AND ADDRESSES. 149 

It has become your proud office to tend the fleshly taber- 
nacle of the immortal spirit ; to mitigate the pangs and com- 
bat the ravages of disease ; to alleviate the suffering and solace 
the sorrows of the afflicted ; to restore to health those stricken 
with disease ; to prolong the lives of confirmed invalids and 
to free the agony of death from bodily pain, and your path, 
if rightly followed, will be illumined by unfettered truth and 
love unfeigned. You must be imbued with the greatness and 
responsibility of your mission, and your obligations are the 
more deep and enduring, because your own conscience must 
be the tribunal to adjudge the penalties of ignorance and neg- 
lect. You cannot appease the conscience with the vain dog- 
mas that the responsibility of misguided judgment and mis- 
applied resource ceases with the individual conviction of right 
or that a life sacrificed in the line of duty is no wrong. This 
question of right or wrong cannot be submitted to the arbit- 
rament of your own conscience nor dismissed with the com- 
placent declaration of your own opinion of right. The tri- 
bunal of justice is at the bar of eternity. 

Health is the priceless jewel in the casket of life, and life 
is the birthright of existence. To your care and skill these 
will be committed, and, in medicine, "confessedly the most 
difficult and intricate of the sciences/' knowledge is not intu- 
itive. It comes only to the earnest and conscientious seeker, 
the diligent and unremitting student, the careful and pains- 
taking investigator. The charlatan may acquire by observa- 
tion and experience familiarity with the effects of his nostrum 
or alleged specific as the grave-digger may acquire expertness 
and dexterity with his tools. In no trade will mankind rely 
upon the skill of an untaught workman. In the ordinary 
avocations of life, in the transactions of business, in the acqui- 
sition of wealth, and in the -attainment of position, the pur- 
pose, end, or aim sought demands fixedness of purpose, sta- 
bility and directness of effort, concentration of mind, and the 
application of every available resource. To these qualities, 
in the discharge of the duties to which you have to-night 



150 ESSAYS AND ADDRESSES. 

been betrothed, you should add the highest ideal of personal 
honor and the most sensitive perception of right and wrong, 
with the quickening influences of a conscience keenly alive to 
the obligations of Christian philanthropy. 

You have been commissioned to " go heal the sick." Ad- 
minister the functions of your office with devotion, steadiness, 
and humanity. " Unite tenderness with firmness, condescen- 
sion with authority, that you may inspire your patients with 
gratitude, respect, and confidence." Bear in silence your cares, 
with dignity your responsibility, with humility your disap- 
pointments, and with becoming indifference that ingratitude 
which you will frequently find is the only requital for ardu- 
ous and self-sacrificing services. 

As ministers of hope and comfort you must not draw too 
sharp a line between health and disease. So long as disease 
afflicts the human family, so long will there exist antagonism 
between health and disease, and from the very nature of the 
circumstances and varying conditions of the faculty of reason 
as exhibited in different individuals, there must exist antag- 
onism between science and ignorance. Disease begets caprice, 
fosters discontent, exaggerates eccentricities, clouds the mind, 
perverts the reason, and masks the judgment. The charlatan, 
often with consummate tact and adroitness, appeals to the in- 
valid with faculties thus affected, and the marvel is not that 
so many yield to the captivating promises of speedy relief, but 
that so many escape the injurious and attractive appliances 
which injure their health and not infrequently destroy their 
lives. As conscientious arbiters you must determine the sig- 
nificance of the symptoms, be they real or imaginary, and 
apply the remedy, be it the comforting assurance of harmless- 
ness or the application of appropriate agents. Few are will- 
ing to accept the confident assurance of returning health with- 
out the employment of remedies, and fewer still will bear with 
patience the painful processes of disease while the physician 
adjures remedies and fosters confidence with verbal assurances. 
The incompetent will strike at random with a multitude of 



ESS A YS AND ADDRESSES. 151 

agents and conceal their ignorance under the accidental adap- 
tation of their formulae. Some will be impressed with an 
assumed devotion; others with a grotesqueness of manner; 
another will be won by winning smiles and a graceful address; 
but, after all, the surest road to success will be through the 
diligent acquisition of knowledge and the faithful discharge 
of responsible duties. 

Hold inviolate the secrets of the sick-chamber. As the 
trusted friend and confidant, the foibles, frailties, and faults 
of human nature, the privacies of domestic life, the infirmi- 
ties of temper, and the defects of character will be intrusted 
to your keeping. 

Now that I have delivered to you the last injunction with 
which your alma mater charged me, come with me into the 
open field of labor, that I may exhibit to you the rugged path 
of duty and picture some of the scenes of coming trials and 
responsibilities. 

Go with me to the chamber of the dying father. He has 
wealth and position and is surrounded by all the comforts of 
life ; his home is amidst admiring friends who delight to honor 
him and to listen to his council. His humanity and benevo- 
lence have gladdened many sorrowing hearts. No one in need 
ever appealed in vain to his charity, and now, in the zenith 
of his career, in the pride of his manhood, he is stricken down 
with disease, and his wasting frame and declining strength 
mark its fearful progress and portend a speedy dissolution. 
Remedy after remedy has failed. The faithful physician 
stands' firmly at his post of duty ; there is no lack of resource, 
no stinting of means, no indirectness of purpose, no frivolous 
pretext to escape responsibility, no unwillingness to confess a 
failure. He is prompt in conclusion, ready in expedient, de- 
cisive in application, but it all avails nothing. That doubt, 
which so often stimulates to renewed effort and* lingers long 
as a wise and faithful counsellor, has yielded to the inexora- 
ble reality. The children, who as duty called them had 
gone forth into the world, have been summoned back to the 



152 ESSA YS AND ADDBESSES. 

homestead. The legal adviser has transacted his last official 
duty and departed; the beloved pastor has administered the final 
consolations of religion, and yet the dying man, still clinging 
to life, appeals with hope for relief and safety to his medical 
attendant. The wife, who has so tenderly nursed him and 
with so much sympathy and anxiety watched over him by 
day and night, true to her womanly nature and affection, has, 
until now, failed to realize his hopeless condition, and, now, 
stricken with grief, crushed beneath the contemplation of the 
hour, leans upon his arm for help, assistance, courage, and 
hope. The daughter, whose young bosom has known no 
sorrow, whose joyous life has been one uninterrupted scene 
of pleasure, to whom the pallor of death and the grief of the 
death-chamber have been strangers, now subdued with terror 
and affliction, comes, with her bosom heaving with sorrow and 
her heart aching with anguish, and implores him, as only a 
daughter can, to arrest the direful malady and restore to 
health the sinking man; and the stalwart son, who has stood 
unmoved amidst the carnage and havoc of contending armies, 
now, in broken accents, inquires if the father must die ? Sym- 
pathizing friends stand near, the man of God still awaits tbe 
departure of the spirit, all, all are bowed in grief ; but in all 
that company there is one unmoved by the scene around, one 
whose emotions must not be seen, whose trembling voice must 
not lose its tone, whose courage must not falter, whose self- 
possession must not yield under the responsibilities of the 
hour. To him alone the sick man appeals for aid ; on his 
skill alone the sorrowing friends and relatives base all hope. 
Experience has taught him that life, though trembling on the 
brink of the grave, may be rescued, and he spares no effort, 
exhausts every resource, in the faithful discharge of his duty, 
until the last faint glimmer of life has gone and the father 
lies motionless and silent in death. 

Now vary the scene. It is the young girl just budding 
into womanhood that is stretched upon the bed of sickness. 
She has been reared in luxury. Every whim has been 



ESSAYS AJS T D ADDBESSES. 153 

indulged, every caprice fostered. She is devoted to fashion, to 
the vanities and frivolities of life, has been petted, courted, 
spoiled — is wayward, self-willed, and perverse. The vener- 
able brother, who has watched over her from infancy and so 
often ministered to her relief, is neither obeyed nor respected, 
and now, after all the precursory symptoms — the first mut- 
terings of the coming storm have been unheeded and neg- 
lected — the disease has gained the mastery. The anxious 
mother and indulgent father, no longer willing to bear the 
responsibility, hastily call the family physician. The way- 
ward girl — though prostrated by disease and its accompanying 
and agonizing pains — is peevish, irritable, impatient of re- 
straint, cannot bear her sufferings with becoming composure, 
and will not submit to the measures deemed conducive to her 
comfort and demanded by every consideration of duty. 
Neither the gentle wooings of an affectionate mother, the 
stern will of an indulgent father, now aroused to the exi- 
gencies of the occasion, nor the patient forbearance of the 
venerable brother can infuse into her stubborn nature a 
proper appreciation of the obligations resting upon her nor 
impress her feverish intellect with the impending peril. 
Through many weary days and nights he watched by her 
side ; but not until the failing powers of life and the wasted 
physique have reduced her to helplessness, when resistance 
yields to necessity and the terrors of eternity appal her, will 
she listen to his counsel and submit to his discipline. Thus, 
conquered by her fears, she is brought to the full realization 
of her dependent and perilous condition, and then, and then 
only, is she moved to acknowledge her error and to express 
her gratitude. But with restored health and returning vigor 
the same inflexible will, the same profligate demands upon 
her constitution, the same disregard of the laws of nature and 
of health, the same love of self-indulgence and gratification 
of the tastes and caprices of her frail nature recur with all their 
original embarrassments. Neither a sense of duty to herself 
nor the entreaties of the loved ones at home, the warnings of 



154 ESSAYS AND ADDRESSES. 

the doctor, nor the progressive inroads of disease can divert 
her from the pursuit of her pleasures and their attending 
evils. 

Again the picture is changed. That generous and gifted 
young man, whose noble impulses, manly bearing, exemplary 
habits, and powers of mind have made him conspicuous among 
his comrades and gave promise of so brilliant a future, to-day 
has partaken of the tempting cup at the invitation of a 
friend ; to-morrow he repeats it to warm his chilled body ; at 
another time to correct the opposite condition ; again, to 
obviate the dangers from some indiscretion in diet and then 
to stimulate his desponding spirits. It soon comes to satisfy 
every need, however contrary and opposite. It is the pan- 
acea for all bodily infirmities and all mental disturbances. It 
arrests disease, invigorates the body, solaces disappointment, 
drives away dull care, stimulates the imagination, revives the 
flagging sensibilities, and, like sleep, " is wearied nature's 
sweet restorer. " These are its beauties and its charms. What 
are its vices, its evil consequences ? Shall I point you to the 
criminal records, the prisoner's cell ? No, there is no need 
of that ; neither is there that I should tell you those noble 
impulses are all transformed into brutal passions ; that that 
manly mien is sadly changed, and that those high aspirations 
have been changed into bitter despair — all these and many 
more evidences of its sad effects and devastating influences 
you can witness any day in the hovels of the poor, in the 
haunts of the wicked, and in the gilded saloons of our gay 
and fashionable city. For its accompanying ailments he 
seeks our counsel, but refuses our advice. He appeals for a 
substitute to slake his debased thirst and to appease his crav- 
ings, and scorns the science which affords no protection from 
the pains of his self-indulgence — no immunity from the inev- 
itable consequences of his evil tastes and passions. The trem- 
bling hand, the faltering voice, the bloated form, the declining 
health, the unsteady gait, the sleepless nights, the enfeebled 
intellect are with him the evidences of his needs, not the 



ESSAYS AND ADDBESSES. 155 

consequences of his vice, and he seeks relief in renewed pota- 
tions. At last the shock, so long delayed, of which he has 
been so often admonished, comes, and the terrible spectacle is 
presented of a human being divested of reason, with perverted 
senses and a form writhing in convulsed and disordered power. 
In this condition he is committed to our care. He sees in the 
glorious sunlight of noonday the consuming flame of eternal 
perdition; in the moving shadows of his dimly lighted room 
the grim and ghastly spirits of comrades gone before, who 
have come back to steal away his craven soul; in the person 
of our patient brother, the evil demon who haunts his dreams 
and consumes his flesh; and he hears in the gentle voices of 
forgiving friends the trumpets of fiends without marshalling 
to his rescue. Behold the monster man — see his glistening 
eye reflecting the fury of his frenzied brain; listen to his 
unhallowed imprecations, to his trembling utterances of the 
coarse and vulgar language of the brothel; see his cowardly 
spirit, now gloating over the fancied triumphs of his valor, 
now cowering under the firm will of his attendant. It were 
better, perhaps, that the emasculated form should go to the 
grave ; but an immortal soul is at stake, and the life is com- 
mitted to our brother's care. He dare not turn away from 
the horrid scene, he cannot abandon his trust, he cannot seek 
repose in the quiet of his own home and leave the life to 
chance. The mortal man and immortal spirit are for the 
time in his keeping, and he cannot divest himself of the hope 
that restored health may bring with it reformed habits. 
Through proper aid and diligent care the sick man slumbers 
in restored consciousness. Now, listen to his plaintive and 
persistent abjurations — to his penitent confessions of the 
woful depravity — to his solemn but insincere renunciation 
of the vice. But I cannot follow him through all the trials 
his life imposes upon our profession. His comrades deny 
complicity in his degradation, his friends excuse his weak- 
ness, and he appeals to us for relief from the many ills which 
afflict his declining life. 



156 ESSAYS AND ADDRESSES. 

It is night : the earth is covered with darkness ; the starry 
heavens are obscured by the storming elements ; the busy 
marts are deserted ; the wearied laborer has gone to his home; 
all animated nature is seeking repose and rest in peaceful 
sleep. How is it with us ? Some lingering doubt disturbs 
our quiet ; some anxious fear renews recollections of the sad 
past ; the body is weary with the labors of the day and the 
mind ill at ease. That young couple in yonder home are 
aroused from their happy sleep by the sudden and alarming 
illness of their first-born, and the messenger goes hurriedly 
for the physician-father. No bodily infirmity can excuse 
him, no faltering will can waive the responsibility. He must 
brave the storm, forget himself ; duty commands him. Love 
for his profession impels him onward to the scene of suffering. 
The little sufferer speaks to him only in the language of dis- 
ease. There is no time for deliberation, no opportunity for 
careful study; the young life, in the agony of its first experi- 
ence, appeals, not for commiseration and sympathy, but for 
that relief which, as the instrument of mercy, he alone can 
give. Whether that sinless soul shall go to the realms of 
bliss or stay to suffer more has not been left to him to deter- 
mine ; but the resulting issue, life or death, is intrusted to 
his care and skill. It lives and reposes in peace and quiet 
in its mother's arms, and on the morrow its playful inno- 
cence and merry gratitude will fill the measure of his recom- 
pense. If it should die, that doubt which has so often been 
the monitor of his skill and yielded to success may linger on 
the painful apprehension of error and foster the keen sensi- 
bilities of his grief. The melancholy emblem draping the 
door-knob is the pang of his sorrow — the memorial of his 
responsibility. 

To-day our city, remarkable for the healthfulness and salu- 
brity of its climate, is free from any prevalent epidemic, and 
its peaceful citizens are directing their energies to the devel- 
opment of its resources, adding to its comforts, its con- 
veniences, and its luxuries. Amid the bustle, confusion, and 



ESSAYS AND ADDRESSES. 157 

turmoil of business, when all seem striving, each in his own 
sphere, for the good of the whole, the physician is quietly, 
wirhout ostentation, pursuing his mission of benevolence and 
philanthropy, unobserved and unheeded save by the afflicted 
few. How many, revelling in health, engrossed in the acqui- 
sition of wealth or drinking deep of the pleasures and gaieties 
of society, have forgotten that health and life may be sacri- 
ficed by some trivial indiscretion. How many scorn rather 
than accept the admonitions of antecedent ailments — deride 
rather than applaud the unselfish suggestions of the profes- 
sion — denounce rather than obey the established laws of 
health — reject rather than follow advice which imposes re- 
straint upon the gratification of tastes and which prescribes 
a limit to the indulgences and excesses of life. Health, un- 
conscious of its frail and uncertain tenure, laughs at medicine, 
acquiring assurance in its temporary immunity, sneers at 
science, and in its joy and pleasure grows fearless of disease. 
Who knows how soon the scourge may come ? To-morrow's 
mail may bring the news of some terrible pestilence decimating 
a neighboring city. As it advances step by step, spreading 
from city to village, from village to hamlet, from hamlet to 
town, it drives before it multitudes of people, stricken with 
terror and appalled at its fatality ; and in that moving and 
frightened throng you will see clergymen and lawyers, authors 
and artists, merchants and tradesmen, all professions and em- 
ployments save one — the physician ; he is not there — his duty 
is in the midst of the pestilence, not in the throng fleeing be- 
fore it. When it reaches our city, comes directly to our homes, 
how soon the scene will change. In the midst of the suffer- 
ing, pestilence, and death our profession becomes pre-emi- 
nently the friend of mankind. The valiant in health will 
then be suppliants for protection — the brave in security will 
cower before the dreaded disease, and the physician then 
achieves the true dignity of his mission — the glorious sub- 
limity of his office. 

Stop a moment here by the wayside, at the home of the 



1 58 ESSA YS AND ADDRESSES. 

widowed mother and of these orphan children. A profligate 
father and a brntal husband has squandered her patrimony, 
and the law, in satisfaction of its just demands, has reduced 
her to penury and want. To feed and clothe these little chil- 
dren — to live an honest and virtuous life — she has yielded to 
inexorable necessity, taxed her feeble strength beyond its 
power, and now, exhausted and worn, is laid upon the bed 
of sickness. No pecuniary consideration moves the medical 
man to minister to her wants. Charity, benevolence, duty, 
are the impulses which prompt him. Noble profession ! 
How pure and unselfish its aims; " the servant of the min- 
istry; the handmaid of religion. He who would become a 
true physician, in the elevated and comprehensive significa- 
tion of the term, must surely attain to the great dignity of a 
Christian hero ; for the path that leads to this high goal is 
through self-denial and an unreserved devotion to the care of 
the sick." Ghouls, harpies, and vampires may wear his title 
and usurp his place even as the false prophet " steals the 
livery of heaven to serve the devil in ; " but they feast upon 
the credulity of the ignorant only. They are never found in 
the haunts of poverty, speaking words of comfort and admin- 
istering to the bodily needs of those stricken with disease. 
The nobility of our profession recognizes no nationality, no 
creed, no condition of life. It is founded on the broad basis 
of Christian philanthropy. It unfurls its banner and marches 
to the fulfilment of its mission of love and mercy, heedless of 
reward — unmindful of everything but duty. It is neither 
swayed by the formalities of society nor dismayed by the con- 
vulsions of popular sentiment. 

A few words more and I am done — do not forget that you 
are only at the threshold of your profession — would you be 
successful, you must continue unceasingly to study; would you 
achieve fame, study must be your watchword ; would you be 
worthy of the high calling you have chosen, study must fill 
your every moment. In the wide domain of useful and .dig- 
nified employments there is none — no, not one — in which the 



ESSAYS AND ADDRESSES. 159 

field before the student is so broad, so ever extending in its 
horizon. Erect for yourself an ideal of achievement and 
steadily march toward it, so shall it be that we who here to- 
night welcome you at the gates of the temple will in the future 
be among your proudest admirers when you shall have reached 
that distinction in its council which you will then have de- 
served. And now, with heartfelt wishes for your happiness 
and success, I bid you God-speed. 



EULOGY 



DELIVERED BY THE PRESIDENT OF THE MEDICAL SOCIETY 
OP THE DISTRICT OF COLUMBIA, FEBRUARY 14, 1877. 

Gentlemen" : It becomes my painful duty to announce 
to you the death of one of our most distinguished members. 
Dr. William Beverly Drinkard died at his residence in this 
city on the morning of the 13th instant, after a brief but 
painful illness. Under ordinary circumstances I might be 
content with this simple official announcement; but as one 
of those who were near him during his last illness, and who 
enjoyed his friendship and confidence, I am not permitted to 
grieve in silence, I cannot withhold a tribute to the memory 
of one so honored and so loved as was our late lamented asso- 
ciate. He was distinguished, as a man, for his uniform court- 
esy, unswerving integrity, and honorable bearing ■ as a phy- 
sician, for his learning, his skill and devotion to duty ; and as 
a brother practitioner, for his urbanity, courteous bearing, and 
high regard for the ethics of professional intercourse. None 
knew him but to love him, and the better one knew him the 
more he was loved. There is not one in yonder grief -stricken 
household, nor here among the companions of his manhood, 
nor elsewhere among his numerous friends, who ever heard 
him utter one harsh word or one unmanly thought. 



160 ESS A YS AND ADD BESSES. 

As he lived, so he died. That courtesy and punctilio which 
characterized his demeanor toward everyone ; that firm and 
heroic will which had so pre-eminently distinguished his career 
from the beginning of his professional studies, and those high 
social and intellectual qualities which had surrounded him 
with so many friends, never forsook him, and never (once) 
yielded under the painful suffering which terminated in death. 
But, perhaps, I can better illustrate his heroism by a narra- 
tion of some of the incidents of his sickness and death. From 
the commencement of his illness till within a few minutes of 
his death he retained all his faculties and never once lost his 
self-possession or forgot his calling. He understood the nature 
of his disease, marked its progress, realized its danger, and 
lent every assistance to his medical advisers, which physical 
suffering would permit, that was deemed conducive to a favor- 
able issue. During Friday night, when his temperature was 
running high and exhaustion was threatening, previous to 
taking some wine (he had never tasted any alcoholic beverage), 
he took his temperature and reading it at 104.5° drank the 
champagne. After awhile he again took his temperature, and, 
returning the instrument to me, remarked, "A primary eleva- 
tion of 0.8°." When the time came to repeat the stimulant 
he again examined his temperature; finding a decline, took 
the wine ; and so at several recurring periods did he make 
the thermal observation before repeating the draught. Dur- 
ing the early part of this scene he invited attention to his 
most distressing symptoms, and several times recalled the 
suggestion of Juergensen in regard to the management of 
certain emergencies occasionally incident to the course of 
catarrhal pneumonia. As early as Friday night he indicated, 
but not until Sunday at noon did he positively express, any 
appreciation of an unfavorable result. At that time he com- 
municated his wish to have an interview with a friend then 
absent from the city, and gave explicit directions how to 
reach the gentleman by telegraph, but added if it could be 
safely deferred until the next day he was content, but that 



ESSAYS AND ADDRESSES. 161 

it must not be too long delayed ; and then, seeming to fear 
the opportunity might not occur, began to state the purposes 
of the conference desired, ceasing only when warned of the 
danger of fatigue. Several times during the following night 
and succeeding day he inquired why the friend had not ar- 
rived; and when finally informed that he could not reach the 
city before 6 a.m. Tuesday, he seemed to dismiss the subject. 
Early Monday morning, in response to the inquiry of a rela- 
tive who had just returned to his room, he said, with his 
accustomed suavity of manner and usual precision of lan- 
guage, " I am better. The night was one of intense suffer- 
ing. I am not, however, out of danger." The hope proved 
delusive. Soon the aggravation of the symptoms denoted ex- 
tension of disease. Thenceforward until the end there was 
unabated suffering and increasing exhaustion. 

When the hour of 6 Tuesday morning had come he re- 
minded me that his friend had not arrived, but waited still 
awhile, hoping the carriage awaiting his arrival at the depot 
might bring him. Then calling me to his bedside he inquired 
if everything had been done, and having been informed that 
our resources had been exhausted, he said, " It will be too 
late. It must be manifest to you that I am dying. For 
four days I have struggled against this, but it is no use; the 
end is near. I must intrust to you what I wished to have 

said to ." Thus he began, and with marked deliberation, 

calmness, and clearness he communicated his requests. This 
interview having been concluded he asked for his mother, 
who immediately entered his chamber from the adjoining 
room. I know not what passed, but in bidding her good-by 
he said: " Mother, next to the immediate family hold these 
friends who have been with me during my illness forever 
in affectionate remembrance." Next he called his sister and 
brother's wife, and then the brothers, one by one ; to each he 
spoke words of comfort, and bade each an affectionate and 
final farewell. Pausing a moment and looking away he sud- 
denly turned toward a brother presenting the infant nephew, 

11 



162 ESSAYS AND ADDRESSES. 

and with outstretched arms he bade Joe come to him, clasped 
him in his arms, kissed him, and returned him to his father. 
Next came the interview with a lady whom he held in high 
esteem, who had remained with him during his illness, ren- 
dering valuable assistance and offering consolation to the 
afflicted family. And now came tottering to his bedside the 
old family servant. He grasped her hands and said : " You 
nursed me during my infancy, and have always been faithful 
to me. I do not wish to die, but it is so," and drawing her 
to him kissed her and bade her, too, a final good-by. He 
alone passed through this trying and affecting scene unmoved. 
Not once did his voice falter, never for one moment did he 
lose himself ; but all his utterances were delivered with such 
calmness as I had never witnessed. After resting for a time, 
seeming to be reflecting whether anyone had been omitted, 
he asked for Dr. Coues, the companion of his boyhood and 
firm friend of his matured years; and to him, when parting, 
he said, " Present my compliments and regards to Mrs. 
Coues." Subsequently he inquired for the family, and when 
told they were in the adjoining room he bade me tell them to 
" remain there and be at his bedside when he died." Later 
still he offered recognition to a valuable friend who had been 
hastily summoned to his dying-chamber. When all this had 
passed the mental aberrations of rapidly approaching death 
began. With an occasional irrelevant inquiry concerning some 
patient and the giving of precise directions to another he lin- 
gered on ; when suddenly, seeming to repossess himself, he 
exclaimed, " Au revoir," and died, surrounded by his family 
and friends. 



ESSAYS AND ADDRESSES. 163 



THE COLUMBIA HOSPITAL AND LYING-IN 
ASYLUM. 

THE COLUMBIA HOSPITAL AND LYING-IN ASYLUM, A 

GOVERNMENT INSTITUTION I ITS PAST AND 

PRESENT MANAGEMENT. 1877. 

The Act to " incorporate the Women's Hospital Associa- 
tion of the District of Columbia" was passed by Congress 
and approved June 1, 1866. 

The following are the more important provisions of this 
Act : 

That the object of the Association hereby incorporated " is 
to found in the city of Washington a hospital and dispensary 
for the treatment of diseases peculiar to women and a lying-in 
asylum, in which those unable to pay therefor shall be fur- 
nished with board, lodging, medicine, and medical attendance 
gratuitously, and to that end full powers are hereby conferred 
on the Association." (Sec. 5.) 

That the "affairs of said corporation shall be under the 
control and management of a board of twelve directors (con- 
sisting in the beginning of the first twelve of the incorpo- 
rators named in the Act) or such further number as the duties 
of the incorporation may require." (Sec. 3.) 

That said corporation shall have i ' power to accept, pur- 
chase, receive conveyances of and hold property, either per- 
sonal or real, to an amount necessary for the full accommo- 
dation, convenience, and support of the institution and those 
participating in its benefits." (Sec. 6.) 

That Congress shall have power to " alter, amend, or re- 
peal" the Act " at any time hereafter." (Sec. 8.) 

In the sundry civil appropriation bill for 1872 there was 
appropriated " for purchase of the building now occupied by 
said hospital, with forty thousand feet of ground, twenty- 



164 ESSAYS AND ADDRESSES. 

five thousand dollars: Provided, That the title of said real 
estate shall be vested in the United States for the use of said 
hospital, and that no part of the real or personal property 
now held or hereafter to be acquired by said institution shall 
be devoted to any other purpose than a hospital for women and 
a lying-in asylum without the consent of the United States. " 

These extracts from the charter determine definitely the 
objects of the institution, and the above clause, quoted from 
the sundry civil appropriation bill of 1872, fixes the owner- 
ship of the " real or personal property now held or hereafter 
to be acquired by said institution " in the Government of the 
United States. If anything further was necessary to settle 
ultimately the rightful ownership of the institution, the an- 
nual appropriations made by Congress for its maintenance 
and support might be cited. 

Statement of annual appropriations by Congress for the 
institution: 1866, $10,000; 1867, $10,000; 1868, not ob- 
tained— probably $10,000 ; 1869,$15,000; 1870, $10,000; 
1871, $18,000; 1872, $18,500; 1873, 52,000 ; 1874, $28,- 
500; 1875, $32,500; 1876, $24,000 — total, $217,000. 
Aggregate, including 1868, $227,000. 

This amount does not include the sums (nor the sums con- 
tributed by the city government, which were considerable) 
annually received from u pay-patients, " which are unknown 
quantities, never having been paid into the United States 
Treasury, or in any manner accounted for. Neither the 
Government of the United States, which has been its munifi- 
cent almoner from the beginning, nor the public, for whose 
benefit it was created, have any knowledge whatever of the 
amount of money received from " pay -patients " nor how it 
has been expended. 

Now that it has been shown that the institution belongs 
(the claim of a portion of the directory to the contrary not- 
withstanding) to the Government of the United States, the 
next inquiry that presents itself is : Has its management 
been proper and commendable ? 



ESS A YS AND ADDRESSES. 165 

The charter declares the purpose of the Association to be 
to " found in the city of Washington a hospital and dispen- 
sary for the treatment of diseases peculiar to women, and a 
lying-in asylum ;" yet numbers of women suffering from dis- 
eases not u peculiar " to the sex have been admitted to its 
wards. Cases of consumption, pneumonia, hip-joint disease, 
malarial, typhoid, and remittent fevers, and other affections 
equally objectionable to the proper hygienic conditions of a 
lying-in asylum have been admitted. 

Chapter XII. of the " By-laws and Regulations/' now in 
force, reads as follows: " Patients will be admitted to private 
rooms in the institution on payment of not less than $6 per 
week, the amount to vary with the room occupied and the 
attendance required. Board payable weekly in advance. This 
includes medicine, medical and surgical attendance/' 

The amount charged varies from $6 to $10 a week in an 
institution owned and supported by the general government, 
which has declared its object to be " to found in the city of 
Washington a hospital for the treatment of diseases peculiar 
to women and a lying-in asylum, in which those unable to pay 
therefor shall be furnished with board, lodging, medicine, and 
medical attendance gratuitously. " The Congress of the United 
States did not contemplate, nor does the language of the char- 
ter authorize, the establishment of a boarding-house for the 
reception of women sick with diseases peculiar to the sex or 
pregnant ; yet the management has so construed Sec. 5 of the 
Act of incorporation, and claims that this feature, thus en- 
grafted upon the institution, has transformed it into a private 
hospital, which can be conducted irrespective of the rights of 
the general government and without responsibility for the 
sums of money received from this source. The number of pay- 
patients is probably never less than one-fifth, and occasion- 
ally may reach one-third of the daily average of patients in the 
institution. The daily average of patients for any year since 
1866 has not probably exceeded thirty, which, at the maxi- 
mum charge of $10 per week for board, lodging, medicine, 



166 ESSAYS AND ADDBESSES. 

and medical attendance, would make the daily cost about 
$43, or nearly $16,000 a year. Yet in 1875 Congress appro- 
priated $32, 500 exclusive of the amount received from pay- 
patients, which, upon the same basis of calculation (one-fifth 
of the daily average of patients at $10 per week), would amount 
to $3,131, which, added to the appropriation by Congress, 
would make $35,631 expended for the support of a daily 
average of thirty patients for one year, or $1,187 for each 
patient per annum. These calculations are based upon a high 
daily average of patients at the maximum cost of pay-patients 
fixed by the by-law previously cited. But it must be mani- 
fest that a number of the pay-patients (perhaps at all times 
one-half of their number) do not pay more than $6 per week, 
a sum, it seems, deemed by the authorities adequate to cover 
cost of " board, lodging, medicine, and medical attendance ; " 
and therefore a rate which should cover the cost of maintain- 
ing the pauper patients in an institution free from rent, 
" taxes, and assessments." If the cost of each patient per 
annum had been estimated upon the basis of $6 per week, it 
would not have been half the amount previously named as 
the apparent cost per annum per patient. 1 There need, how- 
ever, be no speculation as to the daily average or daily costs 
of patients ; for during the past eighteen mouths the number 
of patients in the house has been recorded daily, and Con- 
gress can require the resident physician to produce the record. 
With these data and the aggregate amount of expenditures 
during the same period, any tyro can ascertain the average 
daily cost of each patient in money, to which should be added 
the wear and tear of the luxurious and costly furniture which 
adorns certain apartments. It will doubtless not be so easy to 
ascertain the number of pay-patients or the amount of money 
which they have paid into the treasury of the institution. 



1 A daily average of thirty patients, including the pay and fee, at a weekly cost of 
$6 for each patient, would make the weekly cost $180, or $9760 per annum ; whereas 
in 1876 Congress appropriated $24,000, exclusive of the amount received from the 
"pay-patients." 



ESSAYS AND ADDRESSES. 167 

Many of these pay-patients came from the States ; whether 
brought thither by members and Senators or attracted by the 
ambiguous reputation of its recent chief medical officer, can- 
not of course be ascertained. 

In view of the extravagant expenditures made in support 
of this institution and with the purpose to correct a manifest 
abuse, a number of physicians residing in this city and con- 
nected with other hospitals and medical institutions, presented, 
through Mr. Stevenson, of Illinois, to the first session of the 
Forty-fourth Congress, a bill entitled "A bill to abolish and 
to establish a new Board of Health for the District of 
Columbia, and for other purposes" (House bill No. 3194), 
which contains the following provision, Section 7: " That 
all appropriations made by Congress for the support of any 
hospital, either in whole or in part, shall be disbursed under 
the direction of the Surgeon-General of the United States 
Army : Provided, That the rates allowed by him shall not 
exceed one dollar per day for each patient actually treated in 
each hospital/' and providing further, in Section 8, " that no 
salary shall be paid to any medical officer other than the 
resident physician connected with any hospital supported in 
whole or in part by the Government of the United States." 
The allowance of one dollar per day was based upon the 
ascertained cost of each patient per day in the army hospi- 
tals and upon the contract made by the government with the 
authorities of Providence Hospital for the maintenance of 
the transient sick paupers, for which Congress for many 
years has made annual appropriations. If the government 
can maintain sick soldiers at a cost not exceeding one dollar 
per day, and transient sick paupers at a cost not exceeding 
six dollars per week, why must it pay more than three dol- 
lars per day (including those who are supposed to defray 
their own expenses) for each patient in its hospital for " dis- 
eases peculiar to women and a lying-in asylum ? n 

To recur to the charter. By Section 3 the number of direc- 
tors is limited to twelve, " or such further number as the 



168 ESSAYS AND ADDBESSES. 

duties of the corporation may require/' and Regulation 1, 
Chapter I., prescribes that the " board of directors shall con- 
sist of not more than fifteen members, with one Senator and 
two Representatives added to it by Act of Congress." The 
charter and the by-law passed in pursuance thereof are in- 
definite in regard to the number of directors. Section 2 con- 
fers authority upon the board " to fill all vacancies created 
by death, resignation, or otherwise," and the by-law, Chapter 
I., prescribes that " vacancies occurring in the board may be 
filled at any regular meeting." The number is indefinite ; 
the terms of service are unlimited, and the majority of a 
quorum (seven) possesses the power to fill vacancies at any 
regular meeting, so that the controlling influence can main- 
tain its ascendancy forever by filling or not filling vacancies, 
or by increasing the number, as may best suit and secure 
their purposes, objects, and aims. Such provisions of law 
are against public policy, contrary to the usages of the gov- 
ernment, demoralizing in their tendencies, and conduce inevi- 
tably to the formation of cliques, combinations, and rings, 
which accept any opportunity to promote their ulterior pur- 
poses. No banker or capitalist would engage in an enter- 
prise, with or without a charter, which vested all authority 
in a board of managers indefinite in number, with unlimited 
terms of service, and with indefinite power to increase its 
number or fill its vacancies. Honesty is very prone to cease 
where responsibility terminates. The consonance between 
the language of the charter and the by-laws passed in pur- 
suance thereof clearly manifests the animus which prompted 
the authors of the enactment to clothe the powers conferred 
upon the Association in language so unusual and peculiar. 
He or they projected a great corporation to be held in per- 
petuity by themselves, their heirs and assigns. This might 
be tolerated or excused if any one of the directors had ever 
contributed one penny toward defraying the expenses of the 
establishment or owned a farthing's worth of the property. 
Even the pen, ink, and paper with which their acts, if at all, 



ESSAYS AND ADDBESSES. 169 

are recorded are drawn from the supplies of the interior de- 
partment, and even the printing of letter-heads, etc., is done 
at the government printing office. The addition to the board 
of a Senator and two Representatives by Act of Congress in 
1872 was another of those ingenious devices to promote the 
aims of ring management; for it was easy to secure the selec- 
tion of friends who would stand sponsors for them on the 
floors of the two Houses of Congress. 

In this connection it is proper to allude to the manner in 
which the directors conduct business at their meetings. When- 
ever anything is to be accomplished, as for instance the elec- 
tion of officers, a member who is advised of the purpose to be 
attained moves the appointment of a committee, sometimes 
naming the members thereof, who shall make the nomina- 
tions for the officers, and their report is adopted without 
allowing an opportunity to the minority to express by vote 
or otherwise their preference for others. Thus the president, 
General 0. E. Babcock, the champion engineer of whiskey 
rings, and his coterie of adherents have perpetuated their 
administration of the affairs of the Association. 

The most important portion, however, of the history of 
this national lying-in asylum pertains to its medical manage- 
ment. To Dr. J. Harry Thompson 1 is due the credit of 
conceiving the project and engineering the bill through Con- 
gress, incorporating the Association. He has enjoyed the 
honor, discharged the duties, and reaped the rewards of 
the office of surgeon-in-chief from its organization until the 
20th of September last. Until the fall of 1875 he was prac- 
tially the active and chief fiduciary officer, as well as the 
trusted surgeon of the institution. To him has been awarded 
the merit of securing the extraordinary appropriations from 
the treasury of the United States, and in his person were 
combined the major domo and factotum of the establishment, 

1 The individual who has registered himself on the roster of the Medical Society 
of the District of Columbia as a graduate of the College of Physicians and Surgeons, 
London, but whom the secretary of that institution declares is not a member. 



170 ESSAYS AND ADDRESSES. 

who purchased and dispensed with lavish generosities the 
supplies, hospital stores, and necessary appurtenances. Dur- 
ing the year 1875 the Board of Directors, impelled by the 
force of public opinion and the widespread rumors of wrong- 
doing, took measures at the annual meeting in September to 
reorganize the management of the institution, which culmi- 
nated in December in the adoption of a code of regulations 
which legislated Dr. Thompson out of the direction and off 
the important committees ; took from him the appointment 
of the resident physician and matron ; curtailed his authority 
over the subordinates ; and deprived him of the power of 
purchasing hospital stores and supplies. At the same time 
he was retained as surgeon-in-charge with a salary of $2000 
per annum. The office of assistant surgeon was abolished, 
and at the same time there was organized an " advisory and 
consulting board of physicians and surgeons," to consist of not 
more than eight medical gentlemen residing in the District of 
Columbia. This board was required (by Regulation 4, Chap- 
ter IX.) to " present at each annual and semi-annual meeting 
to the Board of Directors, through their secretary, a report 
of the medical and surgical service of the hospital, with such 
recommendations in regard to securing its greater economy 
and efficiency as their observation may warrant. In addi- 
tion to these reports, communication upon those and kindred 
topics by the Advisory Board, or a majority of those on duty, 
will be received by the Board of Directors through their sec- 
retary at any regular meeting and respectfully considered." 
In addition they were made " counsellors " and required 
(one-fourth being on duty for three months in each year) to 
visit the hospital e< once during each week," and at each 
visit to " report in writing, in a book kept for that purpose, 
the condition of the patients and building." It was further 
provided that " no capital operation shall be performed, 
except in cases of urgent necessity, without the approbation 
of at least three of the consulting board." These were 
wise, judicious, and needful regulations, exhibiting a spirit of 



ESSAYS AND ADDRESSES. 171 

reform, believed at the time to be sincere, and evincing a wish 
to prohibit and mitigate abuses admitted to exist by the 
enforced revision of their regulations and the adoption of 
the prohibitory by-laws. 

The advisory and consulting board entered upon the dis- 
charge of the duties required of them, as set forth in the fore- 
going extracts from the regulations ; and in September, after 
nine months' service and observation, submitted to the annual 
meeting of the Board of Directors a report in writing, " with 
such recommendations in regard to securing its greater econ- 
omy and efficiency as their observation " warranted. These 
recommendations were referred to a special committee, organ- 
ized in the customary manner by resolution naming the three 
constituents. After several months' deliberation the committee 
reported to the directors December 21, 1876. This report 
succinctly sets forth both the recommendations made by the 
advisory and consulting physicians and those submitted by 
the special committee of the directors, and it was adopted. 
These propositions will be considered seriatim. 

" The first resolution recommended by the consulting board 
is in these words: 

" At the request of the surgeon-in-chief the visiting physi- 
cians and surgeons may visit any particular patient as often 
as he (the surgeon-in-chief) may desire them; but in no case 
shall the surgeon-in-chief elect others than the visiting physi- 
cians and surgeons to make such visit. All consultations 
shall be confined to members of the consulting board, and 
no surgical operation shall be performed except by the sur- 
geon-in-chief, or, at his request, by some member of the 
advisory board." 

This resolution the committee recommended the board to 
approve, with the addition of the words " except by request 
of the patient and with the approbation of the visiting physi- 
cians and surgeons/' to the sentence ending with the words 
" such visits;" the insertion of the words " except as above 
provided " after the words i e consulting board " in the next 



172 ESS A YS AND ADDRESSES. 

sentence, and the addition of the following words at the con- 
clusion of the resolution: " or other fully recognized members 
of the profession and with the approbation of the consulting 
board." 

It must be manifest to the most casual reader that the 
object of the advisory and consulting physicians, in making 
the recommendation set forth in the resolution above, was to 
prohibit existing irregularities in the medical management of 
patients ; but the amendments suggested by the committee 
and approved by the directors not only failed to accomplish 
the object, but practically clothed the surgeon-in-chief with 
extraordinary authority and power to secrete, conceal, and 
hide a patient in the house ; for in a subsequent amendment 
it is provided " that no private patient shall be visited, ex- 
amined, or prescribed for by other than the surgeon-in-chief, 
unless by special request of such patient and in consultation 
with the surgeon-in-chief. " Can it be that the Government 
of the United States has established and supports an institu- 
tion in which women suffering from "diseases peculiar to 
their sex " are to. be hidden and secluded from the visits and 
observations of any other than a surgeon whom the directors 
may select? By her "special request" she may be visited 
by another, but such request must come through the indi- 
vidual at whose will she is thus secluded. 

2. " As to the resolution advising the removal of carpets 
from all sleeping-apartments of patients, your committee 
recommend their removal from all rooms used for lying-in 
purposes ; but that they be for the present allowed to remain 
in such private rooms not used for such purposes." 

The object of this recommendation was to promote the 
hygienic conditions of the house as well as in the interest 
of economy; but it was unfortunately in contravention of 
certain speculative tendencies, and carpets purohased at prices 
varying from S2 to §4 per yard contributed amazingly to the 
welfare of impecunious dealers. 

3. " As to the recommendation to admit a member of the 



ESSAYS AND ADDRESSES. 173 

consulting board to all the meetings of the Board of Directors 
for purposes of mutual consultation and explanation, your 
committee are of the opinion that such admission is not neces- 
sary or advisable." 

Of course not. It is not probable that a board of directors 
which had empowered its surgeon-in-chief to seclude and hide 
a sick woman at his will and pleasure would admit to its de- 
liberations one of a board of physicians who were seeking to 
prevent such an act, for he would there confront them and 
their chosen agent, face to face, and be a living witness of 
their purposes and intent. 

The fourth recommendation related to a conflict between 
two of the regulations, which was corrected. 

5. " As to the proposition to abolish the salary of the sur- 
geon-in-chief, your committee are of the opinion that this, for 
the present, would not promote the interests of the hospital. 
Arguments and considerations that would be of great force, if 
this were a hospital for general purposes, fail when we con- 
sider the prime fact that this is a hospital for special purposes, 
requiring special capacities and skill in its chief medical offi- 
cer. We are of the opinion that it is wise for the Board of 
Directors to retain in their hands the power each year to reg- 
ulate and fix the remuneration of its medical officers according 
to their judgment of what will best promote the prosperity of 
the hospital at that time." 

If the committee and the directors had stopped with the 
simple denial of the proposition to abolish the salary, which 
was in exact accordance with the opinion of the physicians 
connected with the other medical institutions and charities in 
the city, it would have been accepted as the expression of 
their opinions, perhaps honestly entertained ; but the reasons 
assigned clothed their refusal with a ludicrous gravity only 
becoming to a directory that would invest the " chief medical 
officer" of a " hospital for special purposes " with power to 
conceal, hide, and seclude from observation and visits sick 
women. 



174 ESSAYS AND ADDRESSES. 

The sixth ( ' recommendation, that the resident physician be 
appointed after a competitive examination by a medical board 
connected with the hospital, and be not allowed to engage in 
private practice," but required to devote his services to the 
hospital, was denied, and the appointment of such officer 
transferred to the surgeon-in-chief. The Government of the 
United States has adopted the system of competitive examina- 
tions for the admission of surgeons to the medical corps of the 
Army, Navy, and Marine-Hospital Service, and for the ad- 
mission of cadets to the West Point and Naval Academies ; 
yet the wisesacres of Columbia Hospital pronounce this sys- 
tem a fallacy and a wrong when sought to be applied to a 
government " hospital for special purposes requiring special 
capacities and skill," and declare " its chief medical officer" 
more competent to select his subordinates than the surgeon- 
generals of the army, navy, and marine-hospital service are 
to select the members of the medical corps serving under 
their direction. The reader will not fail to recognize the 
' ' special capacities and skill " and their adaptation to the 
" special purposes" of either u the chief medical officer" or 
of his coadjutors, who must be credited with a turgescence of 
special administrative capacities. 

7. "As to the recommendation to abolish the duties (office) 
of the surgeon-in-chief and to transfer his duties to a medical 
staff, if this were a general hospital, your committee might 
concur ; but as this is a hospital devoted to special purposes 
and to special diseases and accidents, we are of the opinion 
that such a radical change would be unwise and disastrous 
to the best interest of the hospital, and therefore recommend 
that it be disapproved." 

In consideration of the fact that the recommendation of 
the advisory and consulting physicians to transfer the med- 
ical management of the patients to a corps of physicians and 
surgeons was in exact accord with the methods in successful 
operation in the hospitals throughout this country, in Eng- 
land, Ireland, Scotland, France, and perhaps all over the 



ESSAYS AND ADDRESSES. 175 

civilized world, the action of the directors in rejecting the 
proposition proves, incontestably, their utter incapacity to 
manage the institution properly, and suggests a most extra- 
ordinary subserviency to the domination of unworthy and 
improper influences. The medical reader will recognize the 
comments of "your committee" as the obsolete dicta of a 
by-gone period and the mere repetition of the " argument 
and considerations" of men long afflicted with the "dry rot." 
To them the " special diseases and accidents" of women are 
such novelties that none other than one who might have been 
dismissed as an alarmist from an army in active operation 
could possess the " special capacities and skill" requisite for 
their treatment. 

8. " Your committee also are of opinion that, unless in 
cases of emergency, no examination of patients can be made 
except by the surgeon-in-chief or by his express direction in 
each case, with such of the consulting board as he may select 
to assist him. But no private patient shall be visited, exam- 
ined, or prescribed for by other than the surgeon-in-chief 
unless by special request of such patient and in consultation 
with the surgeon-in-chief." 

Human nature is, fortunately, a very variable quantity and 
subject to many erratic deviations from any fixed standard. 
It is not always easy to estimate the mental calibre or to in- 
terpret the animus of men by their written words. What 
this paragraph means seems plain enough, but what could 
have been the motives which prompted a board of directors 
in charge of a hospital founded by a beneficent government 
for the care and management of indigent sick women to call 
to their aid a board of advisory and consulting physicians 
and surgeons, and then to limit their examination and obser- 
vation to " cases of emergency" and such others as the sur- 
geon-in-chief might direct ? How, under the operations of 
such a rule, could mistakes in diagnosis and in treatment be 
detected and prevented ? How could the poor, indigent sick 
woman be saved from unnecessary operations and mutilations 



1 76 ESSA YS AND ADDRESSES. 

of her person ? It conferred upon a single officer absolute 
power to control the person of every female admitted to the 
hospital, and to subject her to such treatment as might suit 
his whims, caprices, or unfortunate judgment without revi- 
sion or examination by any other person whomsoever. Nay, 
more, without the knowledge of any other than such " as he 
may select to assist him." And this regulation remains in 
force to-day, the written evidence of audacious wrong and 
wilful perversion of the trust confided to their keeping. 
But even this was not the crowning act. They struck from 
Regulation 4, Chapter IX. , before quoted, all after the word 
hospital, and thus forbade the advisory and consulting physi- 
cians and surgeons from making any " recommendations in 
regard to securing its greater economy and efficiency." And 
now the dawn begins to illuminate the darkened picture and 
to bring into view its hidden features and emasculated form. 
The seclusion of patients ; the concealment of mistakes and 
wrong-doing ; the lavish expenditures without accountability ; 
the individual self-aggrandizement ; and the subserviency to 
the behests of a controlling ring are emblazoned in indelible 
characters upon the illumined canvas. 

This series of amended rules, " unanimously approved by 
the Board of Directors," and after being certified to by " O. 
E. Babcock, President," were sent to the Board of Advisory 
and Consulting Physicians and Surgeons. No one will be 
surprised to learn that they all resigned (see letter of resigna- 
tion dated February 2, 1877) ; but many medical men will 
grieve to know that others sought and secured appointment 
to the vacancies. The consulting board, however, was not 
filled to half its proper number until the annual meeting in 
September last. Soon after this wholesale resignation of the 
original advisory and consulting board the trusted surgeon- 
in- charge applied for and obtained a leave of absence for six 
months to visit Europe, and sailed about the first of June. 
He had not departed from the shores of his adopted country 
before rumor credited his long-contemplated visit to the " old 



ESSAYS AND ADDRESSES 177 

homestead " on the Thames, with a sojourn beyond the reach 
of investigating committees, and speedily came rumors also 
of intrigue to secure the contemplated vacancy in the office 
of surgeon-in-charge of the hospital. Our committee, who 
had so exultantly affixed their signs-manual to the certificate 
attesting his " special capacities and skill" — which certificate 
had furthermore been unanimously approved by their coad- 
jutors and certified to by " O. E. Babcock, President " — 
began, as the gamblers say, to hedge and to seek some path- 
way, hitherto unknown to hospital management, by which to 
escape from the dilemma in which they would find them- 
selves in the event a vacancy should occur in the office of 
surgeon-in-charge. They struck out boldly for originality. 
Competitive examinations and division of labor by a prop- 
erly arranged and selected corps of physicians and surgeons 
(as is almost the universal mode of hospital management) 
were to them obsolete methods and inadequate to secure 
"special capacities and skill" in the medical officers of a 
hospital " devoted to special purposes and to special diseases 
and accidents." And so it may be, for the "special pur- 
poses" so vividly delineated in the features of the mongrel 
group of talismanic characters shown on the illumined canvas 
are not the common attributes of simple-minded men, but the 
acquired accomplishments of individuals after long and patient 
tuition in the school where virtue is not taught. 

The directors assembled in the spacious and luxuriously 
furnished office at the hospital building on the night of the 
20th of September last, and across the hallway in the elegant 
parlor sat the aspirants for coming honors, some blushing 
with hopeful expectations and others pallid with apprehen- 
sions of disappointment, but all merry, like poor boys at a 
frolic, for Thompson — it must be spelled with a " p" — had 
resigned and the door-plate had been removed. 

The heavy office-door swung to, the window-sashes were 
fastened down, the president, enrobed in the vestments of his 
office, called to order, and the members, in dignified silence, 

12 



178 ESSA YS AND ADDRESSES. 

sat erect in their cushioned chairs. After an invocation to 
the Congress of the United States for a continuance of its 
munificent donations, a member arose and with oppressive 
gravity announced u the resignation of Dr. J. Harry Thomp- 
son." Of course, it was referred to a " special " committee 
for consideration and report. The resignation was accepted ; 
the office of surgeon-in-charge abolished, and the duties of 
the office transferred to the resident physician on condition 
that he would supply a person to remain in the building 
during his absence in attendance upon his private practice 
outside of the hospital. The salary of the resident physician 
was increased from $1000 to §1800 per annum and a salary 
of $1000 per annum was voted to the treasurer of the insti- 
tution. Heretofore the office of treasurer had not been sala- 
ried ■ but it has been currently reported that the officer had 
been allowed a commission for disbursing the appropriation 
made by Congress, which was paid out of the fund derived 
from the "pay-patients." Recently Mr. Secretary Schurz 
had required, in accordance with the law, that all money 
received from this source should be paid into the Treasury 
of the United States ; and if this was done, commissions could 
not be paid to the treasurer, as the accounting officers of the 
United States Treasury would not allow them in the account. 
The payment of a salary was the device to circumvent the 
action of the secretary. Will the honorable secretary submit ? 
Will the people of this country silently acquiesce in this 
impudent defiance of authority and law ? Will the law- 
making power permit a charter to continue in force which 
sanctions the payment of salaries to its officers from the 
national treasury in direct contravention of the law ? 

No one in this community will impugn the personal in- 
tegrity of the resident physician, a graduate of some five 
years' standing, and a man of more than average ability. 
His friends cherish the hope that he will prove equal to the 
grave responsibility which has been devolved upon him ; but 
others have quailed under less responsibility and frittered 



ESS A YS AND ADDRESSES. 179 

away golden opportunities under improper influences. For- 
tunate indeed will it prove for the institution if he can sur- 
mount the obstacles in his way and emerge from the ruins 
unharmed. With a salary of §1800 per annum ; a commis- 
sariat suitable to the most refined tastes ; all the appurte- 
nances of a spacious dwelling ; the use of a library and an 
abundantly supplied instrument-case, together with the privi- 
leges of a private practice, and all the advantages accruing to 
an institution supported by the bounty of the general gov- 
ernment, it would not be surprising if one less self-reliant 
and capable should track the footprints of his predecessor. 

But the old regime continues in possession; the previously 
cited rules and regulations remain in force. To the reor- 
ganization of this management the medical profession of this 
country and the Congress of the United States must address 
themselves. The former cannot afford to hold its peace and 
sit idly by while a gigantic corporation, deriving its main- 
tenance from the common treasury, is inviting to its spacious 
wards and to luxurious ease the sick women from all parts 
of the country. Nor can it with dignity and self-respect 
withhold its antagonism to an institution which is bringing 
dishonor to hospital management. To this end, then, it 
behooves every individual member of the profession to ap- 
peal to his representative in Congress to place this institu- 
tion under such government as will conduce to economy and 
efficiency, and redound to the honor of its munificent bene- 
factor and to the credit of the medical profession. Transfer 
the appointment of the directors to the President of the 
United States, by and with the advice and consent of the 
Senate, and divide them into four classes, with terms of ser- 
vice of four years' duration, so that one-fourth will go out of 
office annually. Restore the disbursement of the appropria- 
tion to the Treasury of the United States, and require that 
all funds belonging to the institution, from whatever source 
derived, be deposited in the National Treasury. Destroy 
the boarding-house feature of the institution and forbid the 



180 ESSAYS AND ADDRESSES. 

payment of salaries to any medical officer. It is idle to rely 
upon investigating committees. During the last Congress 
the House of Representatives passed a resolution directing 
the committee on the District of Columbia to investigate this 
institution, but no amount of dragooning could force the 
chairman to commence the investigation. Committees can 
be packed, and individual members too often prove too weak 
to resist the blandishments of the corrupt rings which infest 
the Capitol. The directory, with " O. E. Babcock, Presi- 
dent," is a powerful combination — bold, imperious, and 
defiant — and will not fail to seek the destruction of any man 
who may uplift his hand against their wrongs and usurpa- 
tions. Then to the defence of right and condemnation of 
wrong let every medical man throughout this land lend his 
aid. " Meue, mene, tekel, upharsin ! " 



WASHINGTON MALARIA AND THE "CATCHING 
OF COLD." 

1882. 

Malaria and the catching of cold are undoubted factors 
in the causation of disease, and the morbid manifestations 
from both causes are frequently so much alike that differen- 
tiation of cause is not always easily made. Physicians as 
well as laymen constantly mistake the effects of one for those 
of the other, and the ills that 'afflict us are sometimes at- 
tributed to the unavoidable and baneful influences of atmos- 
pheric contamination when, in fact, they are caused by the 
" catching of cold." In the common language of this locality, 
the prevalent ailments are called malarial and believed to be 
the necessary result of even a temporary sojourn in an atmos- 
phere erroneously supposed to be always charged with noxious 
exhalations from the marshes of the Potomac and Anacostia 
Rivers. 



ESSAYS AXJD ADDRESSES. 181 

No one can deny that the extensive river-flats along the 
eastern and southern boundaries, the sluggish stream forming 
the western border of the city, and the Chesapeake and Ohio 
Canal which penetrates the western section, until lately known 
as Georgetown, which is always laden with debris washed by 
the storm-water from the streets, and the filthy products of 
slack-water navigation, present all the conditions necessary 
to the development of miasmata. Nor will anyone excuse 
the neglect which has not only tolerated these long-standing 
nuisances, but permitted them to increase to such an extent 
as to become a disgrace to the National Capital and the cause 
of many forms of disease. Nevertheless, the prevalence and 
certainty of the miasmatic influence do not afford a sufficient 
explanation of the numerous cases of sickness and indefinable 
ailments which habit and fashion ascribe to malaria. 

While, therefore, admitting the existence of conditions 
necessary to the production of malarial diseases, and con- 
demning the inexcusable delay in abating these nuisances, 
my observation and clinical opportunities induce me to doubt 
that malarious contamination of the atmosphere is the exclu- 
sive cause of certain irregular forms of disease which prevail 
in this city, especially during the autumn and winter seasons. 

As yet, malaria has not been isolated as a defined element 
or quantity recognizable either by chemical reactions or 
microscopic characters. It is true that Klebs and Tommasi- 
Crudeli have announced the discovery of a bacillus malarias ; 
but the more recent experimental investigations of Sternberg 
relating to the cause of malarial fevers fail to establish the 
active agency of these organisms in the causation of them in 
man, though many circumstances " favor the hypothesis that 
the etiology of these fevers is connected either directly or 
indirectly with the presence of these organisms or their germs 
in the air and water of malarial localities." Notwithstanding 
this want of positive knowledge in regard to its true nature, 
numerous well-known facts and circumstances have estab- 
lished a belief that a poison is generated from decomposing 



182 ESS A YS AND ADDRESSES. 

vegetable matter under the combined influence of heat and 
moisture, which, when introduced into the system, either 
through the respiratory organs or alimentary tract, will pro- 
duce certain forms of disease, which vary in intensity, form, 
and type according to the virulence of the poison, tempera- 
ture, amount absorbed, and individual susceptibility. For 
the present discussion this definition of malaria is sufficient, 
and excludes all other deleterious emanations and morbid 
agencies, either chemical, gaseous, or parasitic. 

The development of this poison is favored by marshes, 
more especially when containing mixed salt and fresh water 
and resting on a substratum of limestone, clay, or mud ; by 
swampy, undrained, and delta lands ; extensive excavations ; 
newly turned soils ; rains after long-continued drought and 
consequent low water-level ; careless culture of soil ; neglect 
of cultivation where vegetation is luxuriant and is permitted 
to decay on the surface ; and in fact by the requisite com- 
bination, wherever present, of the essential elements — high 
temperature, moisture, and decomposing vegetable matter. 
Nor can it be doubted that it may be diffused in the atmos- 
phere and transported by winds and watercourses to non- 
malarious localities. 

The circumstances which hinder or prevent the generation 
of miasmata are high latitudes, high elevations, drainage, 
sunlight, sandy or porous soil, and cold ; of these, cold is the 
most powerful. The first fall of the temperature below the 
freezing-point in any malarious region arrests the pr cess of 
development, and it does not recommence until the tempera- 
ture again ranges continuously during the day and night 
above 58° F. Malarial diseases are rare beyond the sixty- 
third degree of north latitude and the fifty-seventh degree of 
south latitude. The nearer the equator from either of these 
lines the diseases increase in frequency and intensity. These 
limits are, however, greatly affected by the duration and high 
average of summer heat Hirsch has shown that the average 
summer heat is a more potential influence than the average 



ESSAYS AND ADDRESSES. 183 

annual temperature High elevation presents many curious 
exceptions, probably depending upon geological formations. 
Strata of soil or other impermeable geological formations 
which obstruct or prevent the percolation of the water and 
retain it in a loose surface-soil or in deeper layers containing 
decomposing vegetable matter are frequently the cause in 
many malarious localities. In such regions subsoil-drainage 
is the only effectual preventive. Sewers, with water-tight 
conduits (as they ought to be in all cities) for the conveyance 
of the filth and storm-water, cannot accomplish much toward 
soil-drainage. The cleavage of impermeable strata caused by 
the necessary evacuations may facilitate percolation to a lim- 
ited extent, but is altogether insufficient in those cities stand- 
ing upon soils where the conditions exist which render soil- 
drainage necessary. 

Miasmata are generated more rapidly and the poison is 
more intense during night than during sunlight, and a humid 
atmosphere and rapid evaporation favor its production. Hence 
the salutary influence of solar light is modified by the moist- 
ure of the air, the rapidity of evaporation, and the total move- 
ment of the wind. 

An analysis of the conditions and circumstances favorable 
and unfavorable to the generation of miasmata and their ap- 
plication to this locality lead to the conclusion that this city 
presents other conditions favorable to the production of mias- 
mata in addition to the constantly increasing river-flats, which 
are so universally condemned as the chief cause of malarial 
diseases. The city is located in a basin surrounded by a range 
of hills, broken on the east by the Anacostia River and its 
damp and swampy lowlands ; on the north by Rock Creek; 
and on the west by the Potomac River, which washes the 
entire southern boundary of both cities and emerges from the 
basin, after uniting with the Anacostia at a sharp bend toward 
the south, below the flats, leaving along its southern shore an 
extensive area of swampy land, subject to occasional overflow 
and usually, during the summer, covered with luxuriant 



184 ESS A YS AND ADDRESSES. 

vegetation under careless cultivation, over which the pre- 
vailing southern winds of that season must come. Under 
the centre of the city flows Goose Creek to its sewer connec- 
tion. This was formerly a tributary of the Tiber, but is now 
the common sewer of a densely populated portion of the city, 
quite equal in territorial area to the original drainage-limits 
of this stream. Further eastward is the Tiber, a large and 
sluggish stream, which has its source in the hills above the 
city. It was the main and natural drainage -stream of a large 
part of the northern and northeastern sections of the city, into 
which several lesser streams, lying, wholly within the city- 
limits, empty. After passing the west front of the Capitol 
park it originally turned abruptly westward and emptied into 
the Potomac south and west of the Executive Mansion. This 
part of the stream was diverted by the construction of the 
Washington City Canal, which occupied its bed from its 
mouth to the bend before referred to, and thence extended 
in a southeasterly direction along the valley at the base 
of the elevated plateau upon which the Capitol stands. 
The canal is now replaced by the B Street sewer, running 
westward to the Potomac from West Sixth Street ; thence 
eastward by another sewer connecting at the Botanical Gar- 
den with the Tiber Creek sewer, which from this point fol- 
lows the course of the eastern division of the canal to its 
intersection with the valley of James Creek. Below and 
southeast of the latter point the canal remains open, and is 
the common receptacle of the sewage, soil-drainage, storm- 
water, and filth of that neglected section. It was built for 
commercial and drainage purposes. By its construction (the 
earth from the excavation having been used for filling) the 
marshes and lowlands which occupied for the most part the 
area lying south of Pennsylvania Avenue, and north of the 
reservation known as the Mall, have been reclaimed and are 
now appropriated in part for parks, but mainly for commer- 
cial and industrial purposes. Throughout the extent of this 
reclaimed territory the soil-drainage is inadequate. The 



ESSA YS AND ADDRESSES. 185 

cellars of the buildings are damp and constantly subject to 
overflow by back-water from the Potomac and from heavy 
rains. During the spring of 1881 Pennsylvania Avenue from 
the Capitol grounds as far west as Tenth Street was inun- 
dated ; and in some places the water reached several feet in 
depth, and passengers were conveyed to and from the Balti- 
more and Potomac depot in boats. 

Previously to the construction of the storm -water conduit 
along New York Avenue from West Seventh Street, down 
West Fifteenth Street, and thence through the grounds south 
of the President's house to its outlet into the Potomac at the 
foot of West Seventeenth Street, the B Street sewer was the 
carrier of all the sewage and fall-water from the central and 
most populous part of the city included within the lines of 
the West Seventh and Seventeenth Streets north to Vermont 
and Rhode Island Avenues. The construction of this conduit 
was a very important improvement, because of the incapacity 
of the B Street sewer, and the contemplated diversion to the 
Boundary intercepting sewer of the rainfall and sewage of 
the area between West Fourteenth, North N, and Boundary 
Streets, will be an additional relief to the sewer-mains empty- 
ing into the Potomac. In the B Street area the carriage- 
ways are, for the most part, paved with concrete and asphalt. 
Through it runs Goose Creek sewer. Its subsoil-drainage is 
limited to the percolation along the sewer excavations and 
distribution. 

The Tiber to the northern boundary of the city has been 
arched and converted into a sewer, and now finds its exit into 
the Anacostia through the recently built open sewer along 
the bed of James Creek. The area of the Tiber valley system 
of storm-water drainage and sewage is very large, extending 
westward to the east line of the B Street area, north and 
northeastward along the Boundary Street sewer to its inter- 
section of Maryland Avenue, and is bounded on the east and 
south by Maryland Avenue, East Sixth Street, and North 
Carolina Avenue to its southern terminus at the crossing of 



186 ESSAYS AND ADDRESSES. 

New Jersey Avenue and E Street south. The sewage, rain- 
fall, and waters of the numerous springs formerly scattered 
throughout this territory and the tributaries of the Tiber 
south of the Boundary intersecting sewer are carried by the 
same conduits. The valley of the Tiber and its tributaries 
originally extended far into the eastern and northern sec- 
tions, aud even beyond the northern limits of the city. It 
constituted the largest single drainage-area in the basin. 
Within its borders were several marshes covering large areas, 
notably the localities formerly known as " Swampoodle," the 
vicinity of the Public Printing Office and St. Aloysius' 
Church, and the larger part of the i ( slashes. " The latter 
was a long and narrow strip of boggy and swampy land 
stretching eastward and westward along the base of the hills 
on the northern frontier, insufficiently drained by two small 
streams, one now known as Slash Run sewer, emptying into 
Rock Creek, below the P Street bridge, the other a branch 
of the Tiber. 

It thus appears that the surface of that portion of the floor 
of the basin upon which Washington now stands was origin- 
ally traversed by extensive valleys, and that the central and 
most densely populated part, lying between the Capitol and 
Rock Creek, was, in fact, an island, surrounded by streams 
of running water, marshes, and boggy lowlands. Its sur- 
face was uneven and irregular, broken by numerous eleva- 
tions, depressions, and natural drainage-courses, either sur- 
face or subsoil, which have been mostly obliterated. 

The foregoing description of the soil, marshes, running 
streams, and springs, which were unusually numerous in 
such a small territory as that included within the city's 
limits, has been introduced to show that the natural drainage 
of the subsoil was insufficient, and that consequently there 
were formed large tracts of marshes and swampy and boggy 
lands. The conversion of the streams into sewers, with 
water-tight conduits, has diminished their subsoil-drainage 
capacity, and in fact has limited the soil-drainage to the 



ESSAYS AND ADDRESSES. 187 

sources of the streams and such additional percolation of 
water as may take place in the excavations through the earth 
rammed along the walls of the conduits. How far this dis- 
turbance of natural drainage made necessary by the sewerage 
system may compensate for the innumerable subsoil pores and 
crevices which must have discharged on either side into the 
open watercourses cannot be ascertained. It cannot, how- 
ever, be complete. It is true the conveyance of the storm- 
water from the surface by grading, paving, and sewerage, the 
diminution of the open and exposed area by buildings, pave- 
ment of streets and sidewalks, and especially by the imperme- 
able pavements, have greatly lessened soil-saturation from fall- 
water. The extent of evaporating-surface has also been greatly 
diminished. Whether these artificial interferences have con- 
tributed to the sanitary improvement of the underlying earth 
is an unsettled problem. A porous soil forming the greater 
portion of the floor of a great basin, the surface of which, for 
the most part, is but slightly elevated above the water-level of 
the great streams lying along three-fourths of its circumfer- 
ence, and at the foot of a range of high hills on the other fourth, 
must be subject to constant capillary filtration, even to satu- 
ration, at a depth not far above the water-level in the con- 
tiguous and surrounding rivers. This capillary circulation 
is increased by high temperature, to which the extensive sur- 
face of impermeable aspbalt and concrete pavements is prob- 
ably a very considerable contributor, especially during the 
season when the solar heat ranges above an endurable tem- 
perature. Thus, notwithstanding the diminution of storm- 
water percolation and superficial area of soil-saturation, con- 
ditions are present, during the greater part of the year, which 
promote the capillary circulation throughout the porous strata. 
The exposed evaporating-surface being lessened by the means 
before referred to, the exhalations must find their escape 
mainly through the uncovered parks and spaces, permeable 
pavements, and cellars, basements, and foundations of houses 
not protected by concreted floors and cemented walls. The 



188 ESSAYS AND ADDRESSES. 

evidence of this constant filtration may be noted at any time 
(even though no rain has fallen for days or weeks) by com- 
paring the relative dryness of the brick sidewalks on the 
north and south sides of streets running east and west (most 
marked at night), and in many localities the same condition 
is shown by the walls of buildings for several feet above the 
level of the sidewalk. It is more observable along the streets 
where the carriageways are paved with impermeable mate- 
rial. In the cellars, basements, and ground stories of houses 
unprotected by impermeable walls and floors the evidences 
are even more apparent. 1 will not assert that these emana- 
tions are laden with the poison of miasm, but the supposition 
of its presence is not without some show of reason, inasmuch 
as heat and moisture are certainly, and decomposing vegetable 
matter presumably, present, more especially in those localities 
where the surfaces have been changed by considerable filling. 
The water which oozes through the system of capillary irriga- 
tion may be impregnated, as it is mainly derived from streams 
that have coursed through many miles of malarious territory. 
Even if the exhalation is free from miasmatic poison, the in- 
creased humidity of the air surrounding and permeating the 
walls of dwellings and diffused through the apartments of the 
occupants is unsanitary, and becomes an important and preva- 
lent factor in the causation of the morbid processes incident 
to the catching of cold, which will be considered further on. 

It must not be forgotten also that our summers are long 
and hot. The temperature throughout the months of June, 
July, August, and September — some years a month earlier 
and later — runs continuously during day and night above 
the elevation necessary for the generation of miasmata, and 
also that during the months of greatest heat the total move- 
ment of the wind is less than during other months of the 
year — circumstances favorable to a rapid production and con- 
centration of miasmata. 

The section of the city west of Rock Creek, formerly known 
as Georgetown, presents conditions not less favorable to the 



ESSAYS AND ADDRESSES. 189 

generation of miasm. It is located upon a slope rapidly 
ascending from the water-level of the Potomac to an eleva- 
tion of several hundred feet above the sea-level ; is sur- 
rounded on three-fourths of its circumference by water, with 
Analostan Island and its contiguous marshes in front; is 
penetrated by the Chesapeake and Ohio Canal; its sewerage 
is insufficient; it: is without subsoil-drainage, and is closely 
and compactly built, and with streets narrow and insufficient 
for ventilation and evaporation. The houses are mostly 
built of brick with unprotected foundations and cellars, and 
upon a surface with underlying impermeable strata. High 
above its most populous portion are two large cemeteries, in 
which the number of interments is daily increasing. 

If the result of investigation recently promulgated by Pas- 
teur in his address before the London International Medical 
Congress should be confirmed, that the germs of the disease 
do not die with the death and burial of the victim, but retain 
vitality and the power of reproduction for years, the question 
of the removal of cemeteries beyond the limits and suburbs 
of cities will soon agitate the popular mind of large munici- 
palities. I would not utter one word which could lessen the 
love and respect so universally shown to the dead by the pro- 
tection and embellishment of burial-places ; but we live for 
the living and not for the perishable bodies of the dead, from 
which poisonous emanations may be constantly permeating the 
earth and be diffused in the air we breathe and the water we 
drink. Cremation is repulsive to our devotional and emo- 
tional sensibilities, but may yet become a necessary sanitary 
reform. Life and health are the sum of all values to the 
human being. 

For cleanliness of its streets and general surface this city is 
not excelled, if equalled, by any other known to the writer. 
The admirable system of street-sweeping, the smooth pave- 
ments, undulating surface, prohibition of deposits of refuse 
in the streets, and acquiescence of the people in every effort 
to improve its sanitary condition, contribute to prevent 



190 ESSAYS AND ADDRESSES. 

collections of dirt, filth, and foul and extraneous matter in 
the streets. The garbage department is probably as well exe- 
cuted, and the alleys are kept in better order than is usual 
in large cities. There are comparatively few localities where 
masses of squalid and vicious people are huddled in filthy, 
insufficient, and unfit habitations. There is comparatively 
little poverty, want, and suffering, notwithstanding the large 
proportion of indigent and idle negroes. The climate is 
temperate and salubrious. The plan of the city, with its 
wide streets and avenues, and its numerous parks and open 
spaces, affords great protection against the extension and 
virulence of contagious and infectious diseases. 

The escape of sewer-gas into private dwellings is one of 
the most frequent alleged causes of disease. No intelligent 
physician will deny its deleterious influence. It is a fact, 
however, in this city that the greatest number of deaths from 
zymotic and pulmonary diseases (see maps showing distribu- 
tion of deaths in the annual reports of the health officer for 
the years 1879 and 1880) occur in those parts corresponding 
with the localities of former soil-saturation and now deficient 
soil-drainage, as, for instance, the extensive area originally 
traversed by the valley of the Tiber and its branches, the 
Slashes, Slash Run and its contiguous lowlands, and that 
part known as South Washington. In the latter district the 
drainage is surface and bad, " many of the gutters do not 
carry away the storm, slop, and waste water, and it is left to 
evaporate or find its way into the soil." 

Even if sewer-gas was not an active agency in the pro- 
duction of disease, it is a nuisance that ought not to be toler- 
ated in any habitable dwelling. In some houses the odor 
from foul and improperly cleaused fixed washstands, water- 
closets, privies, and insufficiently ventilated rooms is mistaken 
for sewer-gas ; nevertheless in many others the air is rendered 
impure and unhealthy by its admixture with sewer-emana- 
tions. This is most usually due to the imperfect plumbing 
and house-drainage, and not to defect in the system and 



ESSAYS AND ADDRESSES. 191 

construction of the sewer-mains. The rainfall and sewage are 
carried off in the same conduits, " the principal main sewers 
(see Lieutenant Hoxie's report, 1880), following the line of 
natural drainage," discharge at intervals along the water- 
front, thus securing diffusion and dilution of the sewage. 
The combinations of the systems of sewage and storm-water 
drainage, and the transference of the running streams into 
the same conduits, promote constant agitation and admixture 
with pure water and a more rapid conveyance and greater 
aeration of the sewage, thereby diminishing the generation 
and promoting the innocuousness of the gases. Lieutenant 
Hoxie says " nearly all the gas not due to defective plumb- 
ing in houses is generated in the tidal sections of " the prin- 
cipal main sewers. He believes " the motion of the tides 
driving back these gases at the flood " is advantageous, inas- 
much as it induces motion and promotes their withdrawal and 
replacement by fresh air. The oval " shape of the sewers 
concentrates (Hoxie) the dry-weather flow in the invert, aud 
the large air-space above is favorable to a prompt oxidation 
of such gases as may form during the short time occupied in 
flowing to tide-water." Ventilation is effected by grated 
manholes at short intervals. The chief defect of the system 
is, perhaps, the deficient fall of the sewer-mains. This is 
partially, if not wholly, compensated for by the combination 
of the two systems. It is believed that if the engineer de- 
partment could be clothed with authority to adopt, free from 
the trammels of individual and speculative interests, and be 
supplied with funds sufficient to execute a plan of improve- 
ment and extension, the sewerage of this city would be as 
complete as possible, and far in advance of that of most large 
cities. Even in its present unfinished condition it must be 
admitted that the constantly alleged danger from escape of 
the gases into private dwellings is overstated, except so far 
as it is due to faulty plumbing and house-drainage — defects 
not attributable to the general plan or to the engineer depart- 
ment, but directly chargeable to the negligence of the owners 



192 ESSAYS AND ADDRESSES. 

and builders of the houses. This evil can only be corrected 
by the vigilance and supervision of the health department, 
which has several times invoked the necessary authority, but 
as yet without securing the assent of Congress. Such emana- 
tions, though productive of disease, do not often cause mala- 
rial diseases. 

If not demonstrated, it is very generally believed, that the 
soil of malarious regions contains the malarious poison in 
great quantity, even during the season when malarial dis- 
eases do not affect human beings. It is also believed, and 
medical topography supplies abundant affirmative testimony, 
that moist subsoils, with surfaces exposed to high tempera- 
tures and rapid evaporation, present all the conditions neces- 
sary for the generation of this poison. In such places the 
ground-air may become contaminated and the poison may be 
gathered in the strata of air near or on the surface. Nature's 
method of drainage is by streams and rivers. Ground- water 
seeks the level of the drainage-streams. Rivers receive the 
waters of their tributaries, the tributaries of the lesser streams, 
each of which is the confluent of smaller branches, until we 
reach the rills and rivulets which are formed by the storm- 
water which penetrates the earth and percolates through the 
interstices and pore-canals. The rainfall flows from the sur- 
face toward the sea. The large and smaller streams drain 
larger and smaller areas ; these areas are interspersed, more 
or less, with uplands and lowlands, hills and valleys, moun- 
tains and plains, prairies and forests, and arid and swampy 
lands. Every such tract, however small, has its natural 
drainage-course ; it may be a mere depression of the surface, 
a running rill, or a majestic river. As the larger are made 
of the waters of the smaller streams flowing from sources of 
varying elevation, even up to the plane of the pore-canal, so 
must the height of soil-saturation of the different parts of a 
given area vary with the water-level of its drainage-course ; 
but it can never sink below the plane of the nearest running 
and never-failing stream, and will always be affected by the 



ESSAYS AND ADDRESSES, 193 

frequency and amount of precipitation, the nature of the strata 
of the earth, and the slope of the watershed. The Potomac 
and Anacostia Rivers, which wash the shores of this great 
basin, fix the plane below which soil-saturation can never 
sink. This, in many places, is but a few feet below the nat- 
ural surface ; but, because of the nature of the geological 
strata and other peculiarities of the situation, there are nume- 
rous localities where the point of soil-saturation is far above 
the plane thus established and so near the surface as to be 
reached by the excavations necessary for building-purposes. 
The preceding description of the original topography points 
out such parts, marked by depressions, marshes, swamps, 
springs, and surface-streams ; the maps of the health depart- 
ment, showing the distribution of deaths from certain dis- 
eases, prove the unhygienic condition of such situations and 
their unfitness for purposes of habitation. The diminution 
of the superficial area of storm-water percolation has cer- 
tainly lessened the amount of ground-water, and the construc- 
tion of water-tight conduits has facilitated the conveyance of 
the surface-water to the river-channels. While the transfer 
of the drainage-streams to the sewers has its advantages, it 
is, nevertheless, manifest that such conduits are not subsoil- 
drains, and that the modes of escape of the ground-water, 
especially in some parts, are wholly inadequate for sanitary 
purposes. The filling of depressed parts, and the attempt of 
the late board of public works to reduce the surface of the 
basin to a common level, have obliterated unsightly ponds 
and marshy lowlands, but have not lowered the plane of the 
soil-saturation. In fact, in many places the distance between 
the surface and this plane has been diminished, as may be 
seen after seasons of wet weather, when whole squares of un- 
occupied ground are submerged and adjacent cellars, base- 
ments, and foundations are inundated by soil-water. This is 
more constantly observed in the localities of former marshes 
and places insufficiently drained previous to any artificial dis- 
turbance of the natural topography, and where the natural 

13 



194 ESSAYS AND ADDRESSES. 

drainage has been transferred to the sewer-mains, and such 
percolation as may take place along the excavations. To 
correct these natural unsanitary conditions, and to remove 
the obstructions interposed both by nature and art, are matters 
of grave interest to the permanent population and to the 
national government. As the general surface of the floor of 
the basin is but little above the elevation of the tidal wave, 
it is not probable that engineering skill will ever successfully 
obviate all of the obstacles presented ; but there can be no 
doubt of the value and practicability of a system of subsoil- 
drainage which will lower the subsoil-saturation throughout 
those parts of the territorial area where it is made necessary 
by the geological structure and artificial interference. That 
such a system will contribute greatly to the mitigation of the 
natural defects and promote the healthf ulness of the city there 
can be no doubt, as is illustrated in the improved sanitary 
condition of certain towns and cities in England, where the 
subsoil has been effectively drained. As shown on the maps 
previously referred to, and demonstrated by Dr. H. I. Bow- 
ditch, of Boston, by observations made throughout the State 
of Massachusetts, pulmonary consumption bears a positive 
and constant relation to soil-saturation. The same fact has 
been shown in England by a series of observations made 
under the direction of Mr. Simon, by Dr. Buchanan; and 
the additional fact, also, that this disease had decreased in 
those towns after the drainage of the subsoil, most markedly 
so in those where the level of subsoil-saturation was most 
lowered. Dr. Mead, the medical sanitary inspector of this 
city, makes the emphatic statement (report of health officer 
for 1880) that in certain localities in this city where better 
drainage has been secured a marked decrease has taken place 
in the number of deaths from phthisis, acute respiratory and 
diarrhceal diseases. The city of Detroit was built upon a 
low and wet soil, and it was a very sickly town ; but since 
the improvement in the drainage it has become one of the 
healthiest cities in the country. Dr. Elliot has shown that 



ESSAYS AND ADDRESSES. 195 

in New Orleans, in which city there is constantly present the 
condition of excessive soil-moisture, the mortality from pul- 
monary consumption for the years 1869 to 1879, inclusive, 
nearly doubled that of either yellow fever, malarial fever, or 
diarrhceal diseases, and that the excess of deaths from that 
disease occurred during the six warmer months of the year. 

Ground-air 1 is perhaps neither a less potential nor a less 
frequent factor than ground-water in the causation of disease. 
The popular belief is that the atmosphere ends where the 
ground begins ; but the fact is that the pores of the earth, 
when not filled with water, are filled with air. The quantity 
varies according to the nature of the soil. The greater its 
porosity the more air it can contain. Rubble soil, gravel, 
or sand will hold about 35 per cent, of its mass of air. The 
degree of humidity of a soil represents the amount of ground- 
water, and soil-saturation begins at the lowest limit of the air. 
Ground-air contains a larger proportion of carbonic acid than 
either the atmosphere or the ground-water, and, at a few feet 
below the surface, even more than is usually found in badly 
ventilated dwellings. The quantity is greater during winter 
than summer, and increases with the depth, except during 
the months of June and July, when the percentage is in- 
versed. Pettenkoffer concludes from his investigations that 
the soil is the source of this gas, and is yielded by it to the 
ground-water and ground-air, most freely to the latter ; and 
he believes that it finds its origin in organic processes taking 
place in the soil. Huxley, Haeckel, and others have shown 
that organic life exists everywhere in every porous soil, as 
well as at the bottom of the sea. The more porous the soil, 
the greater the quantity and more rapid the diffusion of air; 
the more active the processes of decay and putrefaction, the 
greater the development of low organisms and the more abun- 
dant underground life. The ground is not only permeable, 
but the air it contains is in constant motion, produced by the 

1 These data have been summarized from Pettenkoffer's lecture on " The Relation 
of the Air to the Soil or Ground-air." 



196 ESSAYS AND ADDRESSES. 

pressure of the atmosphere and wind against the surface ; by 
differences of temperature ; by any and every cause which can 
produce movement; and by the general law of the diffusion 
of gases. The leakage of coal-gas from street-mains has fre- 
quently been known to permeate the earth beneath the street, 
penetrate walls, vaults, and foundations, and escape into 
dwellings at considerable distances from the leak. So, also, 
has the poison of disease been transported by underground 
conveyance. Whatever impurities and pollutions may con- 
taminate the ground-air will be diffused by the current and 
constant change going on. It may be impregnated with 
noxious emanations generated either on or below the surface. 
All forms of filth, the excreta of animals, and the processes 
and products of putrefaction collected upon or under the sur- 
face, or deposited in vaults, cesspools or pits, constitute foci 
from which deleterious exhalations are disseminated through- 
out the ground. In cities and other places where people are 
massed in large numbers in circumscribed areas the soil- 
water and ground-air will be, to a great degree, unfitted for 
the purposes of human life by such poisonous, and, often- 
times, disease-bearing effluvia. They are more detrimental 
to life when received into the system through the ground-air 
than when conveyed through the atmosphere, because more 
concentrated and mixed with larger percentages of carbonic- 
acid gas. When exhaled into the free atmosphere they are 
more easily diffused and diluted, are blown away by the 
winds, and, probably, more speedily oxidized and rendered 
inert. But how can the ground-air reach us ? Currents are 
created by differences of temperature, and will be in the 
direction of the higher. It should then constantly oscillate 
up and down toward the atmosphere and into the earth. 
Fortunately for human life it does this, and in the pro- 
cess the earth is ventilated and the deleterious constituents 
of the ground-air are diffused into space. But this move- 
ment and change of air between the atmosphere and the earth 
is only partial, and is influenced by many conditions and 



ESSAYS AND ADDRESSES. 197 

circumstances, such as the currents and force of the wind; 
formation of the soil ; amount and frequency of precipita- 
tions ; degree of soil-humidity and depth of soil-saturation. 
It comes to us when least expected , and when least resistance 
can be offered to its influences. It comes with high percent- 
age of carbonic-acid gas, with relative high humidity, and, 
perhaps, ladened with the germs of disease. It comes in our 
dwellings, in our sleeping-apartments, during the hours of 
rest and repose, and is most apt to do so when we are most 
securely protecting ourselves from the external atmosphere, 
either because we fear its injurious contaminations or its chill- 
ing influences. It comes under the surface, passes through 
the air, and the permeable walls, foundations, and floors of 
our houses, and poisons the air we breathe. Every house 
unprotected by foundations and walls impermeable below the 
surface is a draft-flue for the earth. The penetration of the 
air through the earth is promoted and facilitated by every 
such house. The warmer the air inside, and the more surely 
protected against the external and free atmosphere, the more 
rapid the current of ground-air through the foundations and 
ground-floors of such dwellings. It is a more constant evil 
during the colder than during the warmer seasons, because of 
the greater difference between the temperature of the houses 
and that of the ground-air. Freezing of the surface offers but 
little obstruction to the circulation of ground-air, and none 
at all to its horizontal movement. In fact, it has been sup- 
posed by some to favor its escape into dwellings and through 
the warmer surfaces. No explanation entirely satisfactory 
has yet been presented for the greater prevalence and intenser 
forms of smallpox, scarlet fever, and other exanthematous 
diseases during the colder than during the warmer seasons. 
The greater number of persons in, and the more constant 
occupancy and diminished ventilation of dwellings, are ad- 
mitted and important agencies. Why may not the ground- 
air, carrying these contagions and penetrating these dwellings, - 
prove a factor in their dissemination equally as constant and 



198 ESSAYS AND ADDRESSES. 

potential ? If it be a fact, as announced by Klebs and 
Tommasi-Crudeli, that the malarial poison is found in the 
soil of malarious regions during the seasons when the tem- 
perature of the atmosphere is below that believed to be neces- 
sary for the generation of this miasma, why may not the 
greater facility and certainty of the admission of ground-air 
into houses at such times explain the prevalence and con- 
stantly recurring attacks of malarial diseases during these 
periods ? The fact is easily demonstrated that many occu- 
pants of houses standing upon made or insufficiently drained 
lands are sufferers from persistent and ill-defined ailments, 
from which relief is only secured by change of dwelling. 
And, surely, if the discoveries announced by Pasteur have 
any substantial basis, the conveyance of the germs of disease 
in this manner is not only possible but probable. It may 
not be practicable to prevent eutirely the pollution of the 
ground-air, but it can be reduced to a minimum, and the air 
of dwellings can be securely protected from such contamina- 
tion by proper construction. Greater cleanliness of the soil 
can be secured by the prohibition of cesspools, privy-boxes, 
and pits, and of other collections and deposits of decaying 
and putrescible material, either upon or beneath its surface. 
A properly arranged and adequate system of sewerage, and 
compulsory legislation requiring a connection with every such 
depository and receptacle will accomplish much in preventing 
soil-pollution. A system of underground drainage will dis- 
pose of the surplus soil-water, lower the level of soil-saturation, 
and purify the earth by promoting ventilation and a more 
rapid percolation of the rainfall to greater depths. The pipes 
of such a system when not carrying water will carry air, and 
thus aeration and ablution of the soil, and dilution and diffu- 
sion of the filth, will accomplish at least a partial disinfection. 
The air of dwellings must be considered in its relation to 
the surrounding atmosphere as well as to the ground-air. 
This relates especially to the study of the processes of catch- 
ing cold. The air of a dwelling cannot be purer than the 



ESSAYS AND ADDRESSES. 199 

atmosphere which surrounds it, and is altered (Pettenkoffer) 
and deteriorated by whatever goes on in it. It is polluted 
by the admixture of substances and altered in chemical com- 
position after it enters the house. Oxygen is consumed by 
respiration, lights, and fires. Carbonic acid and water are 
exhaled from the lungs and skin, and various other extra- 
neous matters are derived from the uncleanly and careless 
management and disposal of the waste and refuse. These 
alterations are partly unavoidable. Interchange is constantly 
taking place between the air outside and inside. No house 
can be protected against this change of air, and if the atmos- 
phere was excluded, it would not be habitable. Ventilation 
is, however, in very many habitations insufficient, because of 
overcrowding, defects of construction, and neglect of prevent- 
able sources of pollution ; and it is a great waste to consume 
fresh air in the aeration and dispersion of such avoidable con- 
taminations. 

The air, both inside and outside of dwellings, is always in 
motion, though this is not always manifest to our senses. 
Ventilation is effected by the constant interchange due to 
motion produced by differences of temperature and by the 
force of the wind, and is regulated by the porosity of the 
walls and the size and number of the apertures and archi- 
tectural openings. The difference of temperature and the 
force of the wind frequently supply the insufficiency of the 
one or the other. By these means spontaneous ventilation 
ought to be sufficient for the purposes of health, provided the 
greatest cleanliness and abstention from superfluous pollutions 
are observed. 

There are, however, many circumstances and conditions 
which interrupt and impede this necessary and wholesome 
interchange. In this city damp and wet walls are among 
the most frequent disturbances of ventilation. Water fills 
the pores of the brick, stone, and mortar, and closes the in- 
lets and outlets of these porous materials so generally used in 
the building of houses. This water is mainly derived, through 



200 ESSAYS AND ADDRESSES. 

the permeable foundations, from the ground-water, which in 
so many places is excessive and near the surface. But damp 
walls not only prevent the passage of air, but disturb the heat- 
economy of the bodies of the dwellers. Water is a better 
conductor of heat than air, and wet clothes are colder than 
dry. Wet walls abstract and absorb more heat than dry 
walls. They reduce the temperature of the room and accel- 
erate the loss of animal heat, thus producing a too rapid cool- 
ing of the whole or parts of the body. In this circumstance 
many cases of sickness find their cause. Colds, catarrhal in- 
flammations, rheumatisms, and kidney diseases (prevalent 
forms in this city) are quite common among the occupants 
of damp dwellings. 

Ventilation and draught are not the same. Both imply 
motion of the air. Ventilation is the necessary chauge of 
air in a closed space taking place without perception of its 
movement. Draught is the motion of air made manifest to 
sensation, and differs from wind only in force and velocity. 
The occupants of wet and damp houses frequently complain 
of and ascribe their ailments to draught, when in fact there 
is insufficient exchange of inside and outside air, because of 
the filling of the pores of the walls with water. In addition 
to vitiation of the air in such houses, there are more rapid 
absorption of heat and lowering of the temperature, causing 
local and one-sided radiation of the body-heat and the conse- 
quent disturbances of the heat-economy, thus producing ail- 
ments which are ascribed to malaria. 

In whatever respect soil-saturation may be considered, its 
influences and effects are detrimental to health. Agricul- 
turists have long since recognized the injury of surplus soil- 
moisture to plant-life, and experience has shown that such 
lands, usually the richest in the elements of plant-food, can 
only be made available by under-drainage ; but not until 
recently, and only by comparatively few even now, have its 
dangers to human health and life been clearly understood. 
Only by the study of the topographical distribution of diseases 



ESSAYS AND ADDRESSES, 201 

and deaths has the direct connection between soil-satura- 
tion and pulmonary consumption been ascertained. And 
though shown to be true in regard to large regions and sec- 
tions, but few are yet willing to believe it equally true of 
single habitations. Until the doctrine that diseases are more 
frequently attributable to personal and domiciliary unhy- 
gienic conditions than to natural causes is more universally 
accepted, but little can be accomplished by preventive medi- 
cine. 

Morbility and mortality bear a constant relation to the 
density of population. This is a factor in all cities. When 
to a superabundant and unclean population are added the 
effects of an inadequate provision for the removal of the 
various excreta, the air becomes permanently ladened with 
noxious elements. This is a city for politics, aesthetics, and 
the sciences, and not for commercial and industrial pursuits, 
and hence ought to be comparatively free from aDy foul mat- 
ters and effluvia, which are the unavoidable accessories of the 
latter occupations. The plan of the city secures constant 
agitation of the air and free ventilation. Its wide streets 
and broad avenues, with their numerous intersections form- 
ing large open spaces, create interchanging currents. These, 
together with the large area of public reservations, promote 
the diffusion, dilution, and escape of the insalubrious and 
detrimental exhalations. As a cause of disease the density 
of the population can never become, as in more populous 
cities, the predominating influence. The area of unoccupied 
territory will always be largely in excess of the occupied. 
Nevertheless, as the value of real estate advances, the cupidity 
of owners will, in small districts or single squares, unless re- 
strained by law, establish numerous foci for the germination 
and dissemination of infectious germs by the subdivision of 
lots, the opening of new streets, the conversion of alleys into 
others, and the erection of tenement-houses upon every avail- 
able space. I might even now cite such localities. The 
proper adjustment of the number of residents to the area, 



202 ESSAYS AND ADDRESSES. 

together with the vigorous enforcement of sanitary regula- 
tions, would greatly lessen the morbility and mortality, espe- 
cially in those districts where overcrowding and filth prevail. 
It is a great mistake to suppose that we have no personal 
concern in nuisances on neighbors' premises. They can 
poison the ground, air, water, and atmosphere, and this 
poisoned air may permeate the earth and convey to other 
dwellings the germs of disease. Our senses may not detect 
the noxious effluvia, but the enemy may find its victim all 
the same. 

It may be asked, How abate the evils complained of ? 
The answer is easy. Reclaim the river-flats; complete the 
system of storm- water conveyance and city sewerage; hasten 
to completion the grading and improvement of streets ; elevate 
the bed of Pennsylvania Avenue from the Capitol to West 
Fifteenth Street ; discontinue the use of impermeable mate- 
rial in the pavement of carriageways and sidewalks; estab- 
lish and execute a system of subsoil-drainage ; obliterate or 
subsoil the parks along the building-lines ; improve and 
adorn the reservations ; extend the Capitol park south to 
the river-shore and connect it with the reclaimed flats along 
the Potomac ; l prohibit by stringent regulations the erection 
of buildings with permeable ground or underground floors 
and walls below the surface of the streets ; straighten the 
channel of Rock Creek by cutting across the horseshoe 
bend at P Street ; hide its filthy shore by an arch, and open 
a park along its course ; and emptying the Chesapeake and 
Ohio Canal into the Potomac above the limits of Georgetown, 
and destroy the unsightly observation of this cesspool of filthy 
water and many stenches. 

This is the capital of a great, growing, and prosperous 
nation, beautiful in design, and susceptible of greater and 
more magnificent embellishments. Every citizen shares the 

1 These additions, with the Monument grounds, Mall, and Botanic Garden, would 
make an immense national park and pleasure-ground, encircling South Washington 
and extending from the Capitol to the Executive Mansion. 



ESSAYS AND ADDRESSES. 203 

wish for its substantial improvement and adornment com- 
mensurate with its importance and capabilities. The time 
may not be very remote, and will be hastened by the speedy 
execution of the necessary sanitary reforms, when the sur- 
rounding elevations will be covered with winter residences 
and summer villas, rivalling in beauty and grandeur the taste 
and display exhibited along the cliffs at Newport. Under 
the present form of government the sanitary condition has 
been greatly improved, but this great nation cannot afford to 
permit the long continuance of the manifest and admitted 
causes of disease which environ and underlie its capital, 
furnishing a constant menace to the health and lives of its 
chosen agents and legislators. Nor should the permanent 
residents stand idle and unconcerned, while the rising genera- 
tions are growing up under the baneful and enervating influ- 
ences with their multiform phases of disease, interrupted devel- 
opment, and broken constitutions. The expenditure required 
to complete the necessary sanitary reform, under the direction 
of the most skilful supervision, would be a magnificent con- 
tribution by a nation of fifty millions of people to sanitary 
science, preventive medicine, and the welfare of a common 
humanity. 

In the f oregoing I have endeavored to set forth the natural 
and artificial unhygienic conditions of this locality ; and have 
indicated in the title that I ascribe the prevalence of two 
classes of disease to these causes, one being due to the con- 
tamination of the air with a special poison, and the other to 
the catching of cold. I have also stated that the clinical 
pictures frequently presented by cases and forms of these 
different classes of disease were so alike that differentiation 
of cause, so necessary for success in treatment, was not always 
easily arrived at. I approach the discussion of the clinical 
branch of the subject with diffidence, because I am well 
aware that the conclusions to which my studies have led me 
will antagonize the opinions of some of my most distinguished 
professional brothers; nevertheless I have no new theories to 



204 ESSAYS AND ADDRESSES. 

promulgate, and will confine myself solely to the narration of 
my own clinical observations. 

The detrimental influences which environ our population 
do not belong exclusively to this locality. One could not 
travel far in any direction from this centre without finding 
other communities no less unfortunately situated. Many 
cities, towns, and neighborhoods throughout the land present 
natural conditions equally and even more unsafe to health 
and life, and exhibit graver errors in hygiene, which yield 
annually a richer harvest in deaths than we have as yet 
offered; but if others have suffered more or less, it is no 
reason why we should delay in securing all that science can 
promise in the prevention of disease. To accomplish this we 
must first ascertain the cause or causes. If in the preceding 
picture I have depicted the work of nature and operations of 
man in their proper colors, I may hope to interest those con- 
cerned sufficiently to arouse them to the dangers which beset 
the present and may befall future generations, and will have 
discharged a duty which professional observation, experience, 
and opportunities have imposed. 

Of the presence in this locality of the two causes and two 
classes of disease referred to there can be no doubt; but 
our knowledge of the nature and infectious quality of the 
malarial poison does not permit an exact determination of 
the relation of this agency to the effects ascribed to it. We 
witness certain results in constant association and connection 
with an unbroken chain of known conditions and circum- 
stances, and from these data deduce an hypothesis which 
affords a reasonable explanation. This hypothesis involves 
two unascertained quantities, the genesis and modus operandi 
of miasma. 

The "catching of cold/' induced by the unusual removal 
of animal heat, either through the external or internal sur- 
face, has long been recognized as an etiological factor. The 
functions of heat-production and -dissipation are regulated 
by nerve-centres. In health the equilibrium is maintained 



ESSAYS AND ADDRESSES. 205 

within certain physiological limits, and though the tempera- 
ture of the body is subject to frequent fluctuations within 
these limits, the chauges are speedily equalized. The tem- 
perature of all parts of the same body is not uniform at the 
same time, owing to the different amount of heat carried by 
the blood to the various parts, to the varying conductivity of 
tissue, and the difference in local production and loss of heat ; 
but a normal range is preserved in health,, though between 
lesser maxima and minima in parts remote from than in those 
parts near the heat-regulating centres. Heat-production is 
increased by muscular effort, lessened by rest, and is least 
during sleep. The increased production must be compensated 
by increased loss, and the lessened production by greater 
protection of the body, else the heat-economy becomes dis- 
turbed and injury ensues, affecting either the whole or a por- 
tion of the body. The body loses heat by radiation, conduc- 
tion, and evaporation, which may be influenced unfavorably 
by external and internal agencies. The external influences 
may be expressed in low temperature, motion of the air, and 
moisture. Either may prove sufficient, but disorder more 
certainly follows their combined influence. It is not neces- 
sary that either or all should be of maximum intensity, for 
slight cooling of the surface by constant change of surround- 
ing air, increased evaporation from the skin moistened with 
perspiration, or increased conduction promoted by a cooler 
medium in contact, does in numerous instances produce some 
one of this group of maladies. Nor is it required that the 
whole surface should be cooled ; a leg or arm, the head or 
back of the neck may be sufficient. Numbers of persons 
have felt the pangs of toothache rekindled by a puff of cold 
air upon the cheek over a decayed tooth, or contracted a cold 
in the head from cutting off the hair in cold weather, or a 
bronchitis from wetting the feet, even in midsummer. While 
it is usual that the part contiguous to the chilled surface suf- 
fers, it is not the invariable law. The place or part of least 
resistance, the weaker organ or tissue, though remote from 



206 ESSAYS AND ADDRESSES. 

the part exposed to the chilling, will frequently exhibit the 
injury sustained. Subject a number of persons of equal age 
and vigor and of average health to the same cooling influence, 
one will escape unhurt, another with a slight sore-throat, a 
third will suffer a severe rheumatism, a fourth will pass the 
ordeal of an acute pneumonia, and the fifth will succumb to 
a pleurisy, the localization in each case depending upon indi- 
vidual susceptibility and the lesser resistance of different 
parts. If, says Seitz, a sensory nerve-tract be implicated, 
rheumatic pains or neuralgia may follow ; should the vaso- 
motor centre be involved, congestion of a special vascular 
area may ensue ; inflammatory processes may be ascribed to 
the transfer of the impression to the nutritive nerves, and if 
the heat-regulating centre be depressed, fever may result. It 
is not necessary that the surface-refrigeration should be long 
continued. The sudden transition from a warm to a cool 
medium, as the passing from an overheated room to a cold 
entrance-hall, or into a strong current, even though the 
change be of momentary duration, will suffice in a suscep- 
tible person, or a person otherwise healthy, who may be the 
unfortunate possessor of a locus minoris resistentice. It is, 
nevertheless, a fact that few can resist the influence of an 
active and protracted loss of body-heat. When at rest or 
during sleep surface-cooling is more certainly and quickly 
injurious than during exercise, because the loss of heat, even 
though it may not be manifest to our senses, is not compen- 
sated by increased production. During exercise the circula- 
tion of the blood is stimulated and surface-heat is maintained; 
but if perspiration is induced, evaporation is increased, and 
this contributes to a more rapid cooling, especially if the ex- 
ercise is followed by sudden rest, and the cooling is promoted 
by the removal of overgarments, and the rest be sought in 
currents of air. Nor is it necessary that the sufferer should 
be admonished by a rigor. The cases of sickness following 
loss of heat are more frequently without than with the occur- 
rence of a chill, and it is this class of disorders which is so 



ESSAYS AND ADDBESSES. 207 

prone to assume chronic and masked forms, finally develop- 
ing either into intractable or incurable diseases. A bronchial 
catarrh, especially in one inheriting the predisposition to 
phthisis pulmonalis, so trifling as not to attract attention, 
may leave hidden in the lung-structure a caseous focus too 
small to be recognized and located, but which by constant 
accretions from subsequent equally trivial and repeated at- 
tacks, each succeeding one the more probable because of one 
or more having preceded, until finally the caseous formations 
break down, and the previous unsuspected disease passes be- 
yond recovery. This chain of unrecognized beginning, im- 
perceptible progress, and final explosion may have had its 
cause in constantly repeated slight surface-coolings during 
rest and sleep, in apartments securely protected against wind 
and storm, but surrounded by walls resting upon soil satu- 
rated with water. The early history of such a case is usually 
that of enfeebled health, with recurring losses and gains, 
trivial discomforts, passing indisposition, unusual suscepti- 
bility to atmospheric changes, digestive irregularities, summer 
improvements and winter relapses, and gradual but progres- 
sive blood-changes, marked, in the further progress, by 
anaemic and masked disorders of graver import, all of which 
are frequently ascribed to malarial contamination, and the 
methods of prevention and cure, based upon a mistaken cause, 
promote and aggravate the morbid processes. The respira- 
tory are not the only organs which suffer from equally slight 
surface-coolings. The alimentary tract is quite as often 
affected, and among very young children the mortality from 
this group of maladies is even larger than from diseases of 
the respiratory organs. No one can doubt the agency of 
sudden refrigeration in producing catarrh of the mucous 
membranes ; and the complex conditions of alimentation and 
digestion, which so constantly imperil the life of infants at 
all seasons of the year, expose the alimentary tract especially 
to the detrimental influences of sudden loss of body-heat. In 
those cities throughout the climatic region of this country, 



208 ESSAYS AND ADDRESSES. 

where infantile diarrhoeas are most prevalent and fatal, the 
fluctuations of temperature during the summer season are 
most acute and intense, and there seems to be a correspond- 
ence between the percentages of mortality and the frequency 
and violence of the sudden falls of temperature. 1 In this 
city the maps showing the topographic distribution of deaths 
show a constant connection between the number of deaths 
from diarrhoeal disease and inadequate soil-drainage. The 
causes of attacks of cold are not, however, limited to the 
unavoidable depressions of the temperature of the atmos- 
phere, excessive soil-moisture, wet cellars and foundations, 
and damp sleeping-apartments. The mother or nurse will 
insist that the child could not have taken cold because it was 
well wrapped when taken out, or was in a carriage with all 
the windows closed, or had not been out for several days, 
but had been kept in a thoroughly warmed room. In the 
closest and warmest rooms there are draughts. The hotter 
the fire in the grate the stronger the draughts converging from 
the various openings toward the chimney. Usually they are 
strongest near the floor, the cold air finding entrance through 
the spaces about the doors and windows. In an overheated 
room the child may have been confined and passed the greater 
part of the day playing on the floor, exposing first one and 
then another heated and moist surface to the draughts trav- 
ersing the floor ; or it may have been out on a long walk 
clad with unusual care and too warmly, and immediately 
upon returning, fatigued and perspiring, its outer garments 
had been removed, and it had rested quietly or slept ; or the 
infant, rolled up in cloaks or furs, may have been carried out 
closely hugged in the arms of the nurse, from whose body 
additional heat was supplied. On returning, asleep, and moist 
all over, its outer wrappings were quickly removed, and the 
child placed to sleep in the crib. In either case a notable 
and rapid cooling would take place, and the detrimental 

1 Mortality of Young Children : Its Causes and Prevention. By the Author. Sani- 
tary care and treatment of children and their diseases. 



ESS A YS AND ADDRESSES. 209 

effect may be quickly exhibited in a sore-throat, an earache, 
a rapidly developed fever, or during the night by croup, 
or the next day by a nasal, intestinal, or bronchial catarrh, 
or, even worse, a pneumonia. 

The defined forms of malarial disease belong to the class of 
intermittent and remittent fevers, and the indefinite forms 
comprehend many of the neuralgic, gastro-intestinal, anaemic, 
and masked affections. The febrile conditions are usually 
easily distinguished by their forms and course. It is, how- 
ever, a well-known fact that in malarious regions many dis- 
eases to which malaria bears no causal relation frequently 
exhibit disturbing perturbations in great variety, due to its 
detrimental influence. It is also a recognized fact that in 
such localities the catching of cold will produce, in those 
who have previously suffered, relapses and recurrent attacks, 
and will hasten and promote the development of some form 
of malarial disease in those in whom the poison may have, 
apparently, remained dormant. These circumstances long 
ago led to the hypothesis, which has been occasionally re- 
vived, that the diseases ascribed to marsh-miasm were due to 
the disturbances of the heat-economy caused by temperature- 
changes ; that malaria was nothing more than the sudden 
chilling of the body previously subjected to a continuous high 
temperature. The few advocates of this theory have not sub- 
mitted it to a crucial test, but have mainly relied upon the 
discrepancies in the testimony in support of the generation 
and absorption of a miasm, and the aberrant occurrences 
of paroxysmal fever under circumstances and in localities 
where the causal relation of miasm could not be established, 
but seemed to be negatived by the environment. It is un- 
doubtedly true that many cases have appeared at places and 
times which, either because of lack of knowledge in regard 
to the development and dissemination of the poison or of 
omissions in the clinical histories of the cases, could not be 
accounted for upon, or reconciled with, the facts believed to 
be established in regard to miasmatic contamination. But 

14 



2 10 ESSA YS AND ADDRESSES. 

as yet there is no instance of malarial fever, as understood by 
physicians, having been produced in a person known to be 
free from the poison, either at sea, 1 away from the reach of 
the land breezes, on high altitudes, or in situations exempt 
and sufficiently remote from the sources of generation, by 
temperature-changes, however sudden, violent, and frequent 
their occurrence. This theory is, furthermore, distinctly 
contradicted by the widespread prevalence of malarial dis- 
eases during those seasons and in those places where the con- 
ditions necessary for the generation of miasm are known to 
be present, as well in those places subject to small as in those 
subject to larger ranges of temperature; by the invasion of 
sections previously exempt, where artificial disturbances of 
the natural topography or long-continued occupancy and cul- 
tivation may have supplied the needed element, but where 
the conditions of temperature do not now differ from those 
in times past ; by the greater prevalence and more intense 
forms as the equator is approached, where the temperature is 
more uniformly high, the diurnal changes less marked, and 
the total movement of the wind is small ; by the marked 
variations in prevalence iu different years in well-known 
malarious regions subject annually to the same, or, at most, 
but inappreciable differences of thermal conditions, but char- 
acterized by larger areas of soil-upheaval and by greater 
exposure of miasmatic foci ; by the comparative protection 
afforded by intervening hedges and groves to the occupants 
of dwellings which, like others, are situated in close prox- 
imity to marshes and subject to like conditions and changes 
of temperature f by the lesser prevalence, under similar 

1 Sir Gilbert Blane, in speaking of bilious remittent fever, says : " I have known a 
hundred yards in a roadstead make a difference in the bealtb of a ship at anchor by 
her being under tbe lee of marshes in one situation, and not in another. It is diffi- 
cult to ascertain how far tbe influence of vapors from woods and marshes extends, 
but there is reason to think that it is to a very small distance. When the ships 
watered at Rock Fort they found that if they anchored close to the shore, so as to 
smell the land air, the health of the men was affected, but upon removing two 
cables' length no inconvenience was perceived." (Bartlett : Treatise on Fevers, p. 395.) 

2 Of the many recorded illustrations the following may be cited : " Mr. P. E. had 
negro-quarters situated on the first prairie elevation above the low grounds of a small 



ESSAYS AND ADDRESSES. 211 

climatic influences, along the bold shores of large bodies of 
running water than along the delta, boggy, and low lands of 
smaller streams with far less evaporating-surfaces ; by the 
influence of different exposures of human habitations to the 
prevailing winds in malarious districts, the occupants of those 
exposed to the direct current of the wind suffering more than 
those of the dwellings sheltered by position or otherwise; 
and, lastly, by the well-known fact that the inhabitants 
of the territory contiguous to malarious marshes, swamps, 
ponds, and rivers suffer less in those seasons when such places 
are filled or overflowing with water, when the thermo-hygro- 
metric conditions are most pronounced, than during those 
seasons when only partially filled and more or less of their 
area, covered, as it usually is, with luxuriant growth and 
decaying and decomposing vegetable matter, is exposed to 
high temperature, moisture, and soil-conditions favorable to 
the generation of the miasm. These and many other facts 
are inexplicable, except upon the assumption of the genera- 
tion of a poison. 

The theory that malarial diseases find their cause in changes 
of temperature involves the negation of all data in support 
of the doctrine of miasm, and necessarily traces to a common 
cause and pathology the classes of maladies believed to be 
due to the absorption of this poison, and those believed to 
be due to the catching of cold. Chilling of the body and the 
entrance of a poison into the system are different processes. 
Chill is a common but a constant initial symptom of malarial 



creek, the fourth of a mile from the houses. This belt of low ground frequently over- 
flowed, causing water to remain in holes over its entire breadth on the subsidence of 
the stream ; but it was well shaded by a dense foliage, the plantation lying on a 
prairie in the rear of the cabins. In the winter of 1842 and 1843 the trees between 
the houses and creek were cleared away, and up to that time, some eight or ten 
years, the negroes living in this quarter had enjoyed uninterrupted health, a case of 
fever scarcely ever occurring. During the summer of 1843, the first after the forest 
had been cleared away, fever prevailed among the negroes with great violence, con- 
tinuing until frost. The negro-quarters were afterward removed to the opposite side 
of the creek, about the same distance from it, but with an intervening growth of 
timber, and no fever has occurred on the place since." (Bartlett : Treatise on Fevers, 
p. 395.) 



212 ESS A YS AND ADDEESSES. 

diseases. The chill of a miasmatic ague is not the algor of 
refrigeration. The former is the cold stage of paroxysmal 
fever ; the latter the shock of heat-loss. The onset of one is 
marked by elevation of the body-temperature, of the other by 
rapid cooling of the whole or part of the body. One begins 
with an increased production, the other with increased loss of 
body-heat. In one the equilibrium of body-heat is disturbed 
by overproduction, in the other by increased loss of heat. 
How miasm introduced into the system produces fever and 
why too rapid cooling of the body is followed by fever are as 
yet unsolved problems. The phenomena attending the advent 
and development of miasmatic fevers denote disturbances pro- 
duced by a poison acting through the blood, which are ex- 
pressed in derangements of nutrition, sensation, secretion, 
physical and mental activity, and in consumption of tissue 
and loss of body-weight. The phenomena following the 
catching of cold indicate a febrile action due to peripheral 
irritation, and are usually associated with or caused by local 
inflammations. The essential element of fever is increased 
production of animal heat. Without it fever cannot exist. 
Wood defines fever to be " simply a state in which a depress- 
ing poison or a depressing peripheral irritation acts upon the 
nervous system, which regulates the production and dissipa- 
tion of animal heat." It seems probable, as has been shown 
by Billroth and others, that inflammatory fevers are due to 
the absorption of some product of inflammation; neverthe- 
less, there are many fevers so trifling that such a grave lesion 
as blood-poisoning would seem to be precluded. Their pro- 
vocation by irritation of peripheral nerves would appear more 
probable, yet with the progress of experimentation the irrita- 
tive forms of fever are gradually yielding to the proof of tox- 
emic conditions. As the effect of the refrigeration of the 
whole or of a part of the body is so constantly exhibited in 
localized inflammatory processes, if further research and ex- 
perimentation shall establish the connection of the sympto- 
matic fever of these inflammations with the absorption of their 



ESSAYS AND ADDRESSES. 213 

products, the sharp lines of a distinct and definite pathology 
will be drawn between the primary fevers of malarial origin 
and the secondary fevers of refrigeration. 

Notwithstanding our limited knowledge in regard to the 
modus operandi of these elements of cause, the differential 
diagnosis between the defined forms of these two classes of 
diseases can usually be made at a glance. The conditions of 
the climate, season, endemic constitution of the locality, ini- 
tial phenomena, and mode of onset are usually sufficient to 
determine the presence or absence of malarial infection. In 
the further progress of the case the paroxysmal character, 
distinct periodicity or tendency thereto, type, form, and 
course of the fever, together with the enlargement of the 
spleen and liver, and appearance of pigment in the circula- 
tory system and many organs, constitute important and usu- 
ally decisive conditions. 

It is not always easy to determine when or how one catches 
cold. The exposure may not have been accompanied with 
manifest chilling ; it may have been prolonged or may have 
been frequently repeated. It may have occurred during con- 
tinuous inclement weather, or may have been caused by the 
abandonment or change of articles of clothing. An attack 
of cold may be ushered in with high fever, quickly followed 
by localized inflammation of a catarrhal or rheumatic char- 
acter, or the fever may follow the development of a local 
inflammation. This reactionary fever may be out of propor- 
tion to the extent of the local mischief, or a simple feverish- 
ness. The fever may be unattended by any local disease, but 
characterized by general malaise, languor, vague and shifting 
pains and aches, shivering and chilly sensations, cold feet and 
hands. The chilly sensations may yield to warmth, but will 
recur upon contact of colder temperature. The patient may 
be warm in bed, and, upon exposure of a leg or turning over 
upon an unwarmed part, a shiver will start up from the limb 
exposed, or the part in contact with the colder surface, and 
run over the entire body, impressing itself most usually with 



214 ESSAYS AND ADDRESSES. 

greatest force upon the back and lower limbs. There is also, 
especially in the milder cases, a tendency to sweat. Com- 
plaint is frequently made of alternate sweatings and feverish- 
ness, of muscular soreness, especially upon changing from a 
position which has been maintained for some time, but which 
disappears gradually during motion, to return again after rest ; 
or of a sense of bruising, as if one had been badly beaten, 
which unfits the patient for exercise and forces him to the 
bed or simply confines him to the house, lolling first on the 
bed and then on the lounge, seeking comfort under adverse 
circumstances, as fretful as a cross baby and demanding more 
attention than a half-dozen ill persons usually require. These 
attacks usually run a brief course and terminate in the resto- 
ration of health. Though it is not uncommon to witness a 
protracted convalescence, or frequently relapses due to neglect 
and perverse disregard of the ordinary care of one's self, until 
finally some intractable condition of ill health is firmly estab- 
lished. 

A feverish cold may be marked by the appearance of a 
group of vesicles on the lips, cheeks, or about the nose; by 
an ephemeral fever of very high grade, which may go as sud- 
denly as it came, leaving only a temporary exhaustion; by 
a copious and exhaustive diarrhoea, which may establish a 
locality of less resistance, to plague the possessor with fre- 
quent admonitions of its presence ; by a slight cold in the 
head, altogether too trivial to account for the intensity of the 
fever ; by a fever continuing after the entire disappearance 
of the local disease ; or by some one of a great variety of 
local manifestations (Seitz) either simultaneous or successive, 
or which may spring up at intervals, in different localities, 
and assume various forms. The fever induced by catching 
cold may run its course unattended with any local manifes- 
tations, but after its complete subsidence a local disease may 
develop. 

The catching of cold may be the " fons et origo" of very 
many indefinite ailments, which mislead both patient and 



ESSAYS AND ADDRESSES. 215 

physician. It may be a persistent weariness, a constant feel- 
ing of tire, an unremitting sense of feebleness, lessened vigor, 
mental and nervous perturbations, attended with a depraved 
appetite, impaired digestion, and faulty nutrition, followed by 
blood-impoverishment and waste, with some one or more of 
its many, multiform, complex, and erratic phenomena. The 
sufferer seeks relief at summer-resorts or at special cure estab- 
lishments ; by drugging with advertised " cure-alls ; " or by 
running to first one and then another physician. But each 
attempt in its turn fails, because the cause has remained un- 
recognized. One physician, mistaking effect for cause, attacks 
the stomach ; another seeks to replenish waste ; a third plies 
the blood with iron and chalybeate waters ; and a fourth, of 
keener acumen than either of his predecessors, traces back, 
link by link, the long chain of morbid conditions, and finds 
the cause to have been a puff of air which had come ladened 
with miasma from the river-flats, and, true to his instincts, 
doses with the universal panacea. These years of more or 
less suffering may be occasionally interrupted by a brief 
period of repair, the result of some fortunate occurrence 
which had drawn the patient for a time away from the cod- 
dling care of overzealous friends and the damp and stagnant 
air of the family dwelling. Thus equipped with better blood, 
an improved physique, and hopes brightened by the prospects 
of recovering, the patient returns to the customary home and 
habits and soon relapses, perhaps even faster than the gains 
were made, into an equally deplorable if not a worse condi- 
tion. Another change is sought, probably a voyage across 
the ocean and a tour through Europe. This chase after 
health, with its constant change of scenes, places, and habits, 
but mainly from prolonged absence from the unwholesome 
domicile, may establish a standpoint not far removed from 
the level of the miseries from which nature refuses to recede. 
It may be that, with the changing conditions of life, health 
will vibrate between bad and worse until some fortuitous 
circumstance transforms the habits of life and changes the 



216 ESSAYS AND ADDRESSES. 

place of residence, and then the turning-point is reached ; or 
it may be that some magic influence lightens the burden and 
desolation of long suffering by abruptly separating subject 
and cause, and life rejoices again in restored health ; or it 
may be that the rays of hope come and go with the transitory 
improvements of chronic invalidism which progresses through 
the regular gradations of an incurable and fatal disease. Many 
fatal heart affections have found their beginning in slight sur- 
face-coolings, produced by the proximity of damp walls in 
sleeping-apartments, or the cold air ascending from permeable 
ground-floors and foundations. Slight rheumatic pains mark 
the initial stage, then comes a sharp attack of joint-rheuma- 
tism, with intense fever and heart complication; later the 
murmur of valve lesion is heard, faint at first but increasing 
with time, succeeded by degeneration of the heart-muscle, 
and finally general dropsy with its attendant suffering closes 
the distressing scene. 

Fortunately for many wayward and indiscreet people, the 
detrimental effects of refrigeration are not always so grave 
or so disastrous to life. The minor ailments which are so 
commonly ascribed to the unavoidable and baneful influence 
of malarial contamination most frequently find their cause in 
the indiscretions of everyday life. Women who are accus- 
tomed to all the comforts that wealth can bestow, and who 
take special care to protect their person when going to walk 
or drive, will go to an evening entertainment with bared 
necks, arms, and heads, with thin boots or slippers, and with 
insufficient underclothing, in conformity with the usages of 
society. But even this reprehensible custom would not so 
often entail pain and disease if ordinary care was exercised 
during the stay at the place of resort. In the crowded and 
heated rooms, excited by the congenial companionship of 
friends and the exhilaratory influences of the general good 
humor and conviviality, the system becomes a bonfire to the 
emotional excitement and pleasures. The heart beats fast 
and faster and the blood is driven with increased rapidity 



ESSAYS AND ADDRESSES. 217 

through the distended vessels. The whole surface vascular 
area is flushed with hot blood. Thus overheated, and per- 
haps to rest from an animated conversation or a dance, with 
a glowing and moistened surface, the peripheral vascular sys- 
tem overfilled with hot blood, and a radiating area equal to 
the entire surface, the unprotected body is suddenly exposed 
to a draught blowing through an open window or door, or 
to the colder air of the hall, or even to the open atmosphere, 
and the vast volume of overheated blood is rapidly chilled 
and driven back to the interior. Surface-heat is lost too rap- 
idly, and the cooled blood, sent back to the overheated organs 
and tissues, absorbs their heat too rapidly. The bonfire is 
extinguished, but the embers smoulder in angry recognition 
of the wilful or thoughtless disregard of nature' s plainest pre- 
cepts. Why wonder, then, that colds, coughs, neuralgise, 
catarrhs, digestive disturbances, pains, aches, or some more 
serious disorder, should torment the devotee of arbitrary 
fashion and custom ? And is it any less surprising that the 
sufferer should ascribe to nature and nature's methods the 
cause ? The river-flats lie in broad expanse along the water- 
front, and marsh-miasmata offer a convenient and plausible 
excuse to cover and hide one's own derelictions. 

Men are quite as often guilty of even more flagrant abuses 
of their constitutions, not only by excessive excitement of 
purely physiological functions and processes, but by artificial 
stimulation of the nervous and vascular systems. Alcohol is 
one of the most diffusible and powerful of the heart- stimu- 
lants. It accelerates the movement of that organ and in- 
creases the frequency of the pulse. By this increased action 
the blood is driven with greater rapidity through the vessels. 
The rapid flow of the alcoholized blood to the heat- regulating 
centres increases heat-production, and the temperature of the 
body is elevated. The surface-area of radiation is increased 
by the greater quantity of blood flowing into and through the 
distended capillary system. The surface-vessels are flooded 
with overheated and poisoned blood. When to this condition 



218 ESSAYS AND ADDRESSES. 

is added the influence of unusual exercise the ill effect is aug- 
mented. With a greatly increased quantity of blood in a 
greatly iucreased surface-area exposed to a colder medium, 
heat-loss is vastly augmented, and chilling is much more 
rapid and effective. Such a condition may be produced by 
a single drink, and certainly will be by frequent potations of 
alcoholic beverages. Alcohol also poisons the intelligence. 
The first sense of satisfaction and beatitude is quickly fol- 
lowed by intellectual excitation and hyperideation, which is 
characterized by lack of moderation, impaired judgment, and 
loss of will. To these excitant stages others succeed, with 
which too many men are personally so familiar that mention 
is unnecessary beyond the statement that a drunken person 
loses heat faster, and will freeze sooner, than a sober one. 
Alcoholism promotes the catching of cold. The combination 
of poisoned intellect, poisoned heat-regulating centres, stimu- 
lated circulation, poisoned blood, and a dilated and overfilled 
cutaneous vascular system, promotes, facilitates, and augments 
the chilling influences. It is most frequently and far too often 
illustrated in the daily life of some men, and but few are will- 
ing to acknowledge that either the trivial or graver ailments 
before referred to ever originate in the pleasures of the cup, 
but ascribe their cause to the emanations from the river-flats, 
and base their prevention and cure upon the antidotal prop- 
erties of alcohol. Every bummer in the city and everv vic- 
tim of chronic alcoholism claims to be a sufferer from chronic 
malarial poisoning, and it is no unusual circumstance to see a 
group of them sunning themselves during the ague stage in 
front of some saloon. But others beside professional bum- 
mers delude themselves by this ratiocination. The habitual 
u diner-out" attributes to malaria the deluge of ideation and 
nightmares, and the lightning-flashes of pain which disturb 
his rest and make night hideous, and hurls with measured de- 
liberation the usual anathemas against a climate which will not 
permit rest at ease and refreshing sleep with a stomach over- 
loaded with the good things of life and the blood saturated 



ESSAYS AND ABDBESSES. 219 

with the choicest wines. The high liver and overfed man 
ascribes his stomachic troubles, aching and dizzy head, 
confused mind, languor and disinclination to exercise, de- 
pressed spirits, and irritable temper which make all about 
him unhappy and himself the most miserable of all, to bil- 
iousness of miasmatic origin, and cites with intemperate 
vehemence the salutary effect of a half-dozen after-dinner 
pills and the routine doses of quinine ; but he loses sight of 
the benefit derived from the rest and abstemious diet which 
an injured and overworked stomach can secure only through 
much travail and many tribulations. To illustrate the fre- 
quency of alleged malarial infection as the cause of sickness 
which should be attributed to vices of diet, habits, imprudent 
exposures, or some one or more of a great variety of excesses, 
I will briefly refer to the cases of four gentlemen from dis- 
tant and different parts of the country, winter sojourners 
here for the first time, who were accustomed to the simple 
habits of prudent people at home, unused to late hours, and 
strangers to terrapin-suppers and the usual accompaniments. 
One has lived many years in the valley of the Wabash, 
another near swamps in the Carolinas, a third is from pious 
New England, where malaria was unknown until the Eebel- 
lion came, and the fourth has passed the life of a cosmopol- 
itan and has seen malaria so dense that it could be sliced into 
blocks. All have, many times, had old-fashioned fever and 
ague, with chills which shook their joints loose and made 
their hair stand on end ; but neither had ever before lived in 
a climate where malaria followed people in fierce pursuit at 
every turn during the day, howled under the eaves at night, 
stole through the stomach, and sneaked in under the nether 
garments. They are gentlemen of elegant leisure, equipped 
with ample means and a generous hospitality, and are here 
for pleasure and intellectual recreation, and to teach the good 
people how best to make life's cares pass swiftly and merrily. 
They have, week after week, gone the round of dinners, high 
teas and suppers, of card-parties, theatre-parties, and aesthetic 



220 ESSAYS AND ADDRESSES. 

reunions ; and wasted their unoccupied leisure, when other 
people are toiling, in busy preparation for the succeeding 
entertainment — one by drenching himself with mineral waters 
to tone up his stomach, another to clear his head, a third by 
squeezing his liver with some popular nostrum, and the fourth 
slumbered under the gaslight that the sunshine might not dis- 
turb his reveries in dreamland. This contest of pleasure and 
excess against physiological endurance has, as is usual, added 
four to the list of the vanquished, and, notwithstanding the 
antidotal drink and dose of quinine, each ascribes his present 
condition to the horrid atmosphere which custom and habit 
allege is saturated with malarial emanations from the river- 
flats, even during the season of the year when the tempera- 
ture is far below the point necessary for the generation of 
miasmata. Neither will accept the suggestion that the blood 
alcoholized and overheated, the stomach overladen with food 
and viands, or . the nervous system overstrained by artificial 
stimulation, bears even a causal relation to the ills which so 
sorely afflict them. And so thoroughly are they imbued with 
the popular and erroneous belief that either would rather go 
to the grave through years of wretched suffering, penury, and 
want, or the mad-house, than have health upon the basis of 
an abstemious and prudent life. 

It is not probable that the abuses of human life will ever 
cease, or that the defective construction of human habitations 
will ever be wholly prevented, or that the unsanitary condi- 
tions of cities will ever be completely cured. Nor is there 
any natural requirement of life that necessarily entails dis- 
ease, yet few of those born die by natural decay. To the 
avoidable causes of disease far the larger number of deaths 
are due. It is only by the education of the masses in the 
methods of prevention that the science of medicine can attain 
its proper position and influence among mankind. 



ESSAYS AND ADDRESSES. 221 



WASHINGTON OBSTETRICAL AND GYNECO- 
LOGICAL SOCIETY. 



BEFORE THE WASHINGTON OBSTETRICAL AND GYNE- 
COLOGICAL SOCIETY, OCTOBER 5, 1883. 



CRANIOTOMY UPON THE LIVING F(ETUS IS NOT JUSTIFIABLE. 

Gentlemen : The meeting to-night completes the first 
year of the existence of this Society, and it gives me pleasure 
to congratulate you upon the success attained. 

The duties of the presiding officer have been exceedingly 
light and pleasant. During the entire session there has not 
occurred a single infraction of the rules and courtesies of de- 
portment, or of parliamentary order or decorum, and there 
has been but one failure to comply with the individual obli- 
gations of the members. The attendance has been prompt 
and the average unusually large. 

The essays aud discussions have exhibited study, thought, 
and a high order of professional and scientific attainment. 
There has not been one indifferent paper submitted. The 
zeal and enthusiasm displayed by the essayists should com- 
mand the admiration of the entire membership, and every 
member must acknowledge the value of the instruction de- 
rived from the efforts of his colaborers in this field of obstet- 
ric, gynecic, and pediatric study. 

This young and vigorous Society has not, however, been 
permitted to complete its first year's existence without a sor- 
row. The memory of the lamented Ashford lingers in the 
freshness of commingled affection and grief. We who knew 
him so well, who had learned to value the qualities of his 
heart and mind, and had so often listened to his terse and 



222 ESSAYS AND ADDRESSES. 

cogent utterances, will not soon forget our friend, companion, 
counsellor, and coworker. He died at the early age of forty- 
two, yet had made for himself a reputation which but few 
can hope to attain, and he has left to his friends and family 
the heritage of an untarnished name and spotless character. 

Medical societies with limited memberships, for the mutual 
instruction of their members in special departments of the 
science of medicine, have become quite common in the larger 
cities, both abroad and at home. Societies similar to our own 
have been established during the last decade in many cities no 
larger than Washington. The time has surely come when it 
is the duty of those who are especially interested in the study 
and practice of obstetrics and the diseases of women and chil- 
dren to unite and concentrate their individual efforts for their 
common good. The results in other places have demonstrated 
the literary and scientific advantages of similar organizations, 
and it cannot be doubted that this city possesses professional 
talent which will cope with the highest order of medical intel- 
lect. This position cannot, however, be won if individual 
capacities and acquirements are confined to the privacy and 
isolation of the sick-room. Enlarged thought and advanced 
study demand the broader field of intellectual comparison, 
analysis, and trituration. These desiderata can only be se- 
cured by organized effort, systematic presentation of well- 
considered opinions, clinical experience and observation, and 
the examination and discussion of these by men engaged in 
the same field of scientific labor. The success of the past 
year gives assurance of the complete fulfilment of the para- 
mount objects of the Association. The first being mutual 
improvement in scientific knowledge and practical skill, and 
the second a more intimate mutual acquaintance and personal 
intercourse. 

A careful record of the proceedings and the publication of 
its transactions constitute the chief incentives to intelligent, 
systematic, and persistent work. No medical society pros- 
pers long and continuously without these aids. Upon the 



ESSA YS AND ADDRESSES. 223 

recording secretary and committee of publication important 
duties are devolved, to the complete and impartial discharge 
of which the continued existence and success of this Society 
mainly depend. The committee should be clothed with full 
and necessary powers, and the Society should hold it to a 
strict responsibility. The duties, though very onerous, are 
too important to be neglected, and the committee should feel 
that the life, usefulness, and standing of the Society will be 
the measure of a careful and exact observance of its duty. 

It would be invidious in me to select any one of the papers 
read before this Society for special commendation or criticism. 
It will, however, be pardonable to recall your attention to a 
subject which, in somewhat different aspects, was discussed 
on several occasions. 

I am induced to refer again to the justifiability of the 
operation of craniotomy upon the living foetus because of the 
great importance of the subject and the increasing interest 
which it is now exciting, hoping that with the re-examina- 
tion now in progress there will result a modification of the 
extreme views which have been held by a large majority of 
the ablest and most renowned obstetricians of the past, and, 
perhaps, of those living of equal ability. 

IS CRANIOTOMY UPON THE LIVING FCETUS A JUSTIFIABLE 
OPERATION ? 

It is, probably, the most ancient of obstetric operations, and 
the hook and perforator are, perhaps, the most antique of ob- 
stetric instruments. The operation means death and mutila- 
tion of the foetus, and is performed solely in the interest of 
the mother. When the foetus is already dead it is an accepted 
procedure, within certain well-defined limits, to effect delivery; 
but then, as well as when the foetus is living, it demands skill 
and dexterity. In a large percentage of cases it is attended 
with serious dangers to the woman, and, according to Churchill 
and Tyler Smith, with a mortality in the proportion of one to 



224 ESSAYS AND ADDRESSES. 

five. Many other authors claim a higher death-rate, and a 
few a lower one. When performed upon the living foetus it 
necessarily involves the deliberate killing and mutilation of a 
human being. In every case of labor two lives are more or 
less in danger. Fortunately, in a vast majority of cases, both 
lives are conducted safely through and past the perils of par- 
turition. For the comparatively few cases in which delivery 
cannot be accomplished without artificial aid the operation 
of craniotomy was originally devised in the interest of the 
mother, and from the times of Hippocrates and Celsus it has 
been recognized as a justifiable procedure, even when the 
foetus was alive. 

In the remote periods of antiquity many pregnant women 
must have perished in the travail of labor, undelivered ; but 
even after the invention of the hook and perforator, and 
through all subsequent time down to the present, with the 
progressive improvements in instruments, advances in obstet- 
ric knowledge and science, and the acquisition of manual dex- 
terity, no operator has ever yet assured the life of the mother, 
even after the life of the foetus had been sacrificed, and the 
best result that can be offered is, according to the standard 1 
of Churchill and Smith, the saving of the lives of four mothers 
out of five, or, in other words, the saving of four lives out of 
ten imperilled. 

In the earlier times, when obstetric operations had their 
beginning and were at best performed with rude appliances 
in a bungling and unscientific manner by operators lacking 
knowledge and experience, the preservation of four lives out 
of ten which would certainly have perished must be cherished 
as a blessing to humanity, and the means by which it was 
accomplished must be regarded as a great advance in the 
obstetric art. But as yet there is no proof that Hippocrates, 
Celsus, or the Arabian physicians ever deliberately destroyed 

1 In view of the advantages of antiseptics in surgical operations, this standard may 
be unfavorable to craniotomy, but as the object is to illustrate the fact that it is 
attended with a mortality, not now possible to ascertain, it answers the purpose. 



ESSAYS AND ADDRESSES. 225 

the life of the foetus preliminary to the extraction of the muti- 
lated body of the unborn child. It may be that their mor- 
tality of mothers was greater, perhaps far greater, than it is 
to-day; but when Baudelocque and Kluge rated it at more 
than 50 per centum, Rokitanski at 41, and Hemming, Jones, 
Churchill, and Smith at 20, the comparison of our later- 
known results with the unknown of the remote past does not 
conduce to a very high appreciation of the progressive im- 
provement in the operation of craniotomy. If, however, the 
question of mortality be studied chronologically, it will ap- 
pear that the death-rate of mothers has diminished with the 
lapse of time aud advance of obstetric science, and that it is 
now less than at any former period. It must, nevertheless, 
be admitted that while the mortality of mothers has been 
diminished by the more dexterous performance of the opera- 
tion and the better management of the cases, the relative pro- 
portion of foeticides has greatly increased, and the sum total 
of lives lost and sacrificed has been greater during the present 
than during any previous century since the operation was de- 
vised. The more frequently the operation is performed on 
the living foetus the greater the number destroyed, for half 
of the lives imperilled must necessarily be sacrificed, and the 
chances of saving the remaining half can only be enhanced 
by a percentage equal to the death-rate of the mothers, what- 
ever that may be. The most expert and experienced operator 
cannot save more than half the lives at risk, and the more 
dexterous the greater the number of ventures, consequently 
the greater the loss and sacrifice of life. No one has or can 
hope to attain the success of saving a possible 50 per centum 
of the lives at stake. 

Just here I will be confronted with the statement of those 
who have performed one, two, three, four, or five cranioto- 
mies without the death of a mother. The assertion of such 
a fact is probable proof that the operations were hasty and 
unnecessary. The successful craniotomist, more often influ- 
enced by ambition than judgment, and dazzled by the desire 

15 



226 ESSAYS AND ADDRESSES. 

to gain an additional success, precipitates the death of the 
foetus that the dangers of delay may be avoided. If it is 
justifiable during the lifetime of the foetus, it is best to pro- 
ceed to its execution before the exhaustion of the patient by 
ineffectual efforts, and before the contusion of the soft parts 
incident to attempts to effect delivery by the more conserva- 
tive intrapelvic methods. But if such a rule should become 
the established practice, it is only the exceptional few who 
can avoid the guilty killing of a human being in cases where 
delivery of a living child might have been accomplished per 
vias naturales. Even so distinguished an obstetrician as Al- 
bert Smith 1 relates a case where a living child was born while 
a messeuger had gone for the instruments of death, and 
more than once the shocking illustration of bungling haste 
has been exhibited in the cries of a mangled infant. 

Craniotomy offers no hope, not even a ray of the promised 
life to the unborn; but proclaims from the altar of profes- 
sional justification death by violence to the foetuses of women 
who are physically incapacitated to give birth to a living 
child. Nay, more, it offers immunity from the travail of 
labor, and protection from the annoyances of maternity to 
those who have accepted the pleasures of concubinage or wed- 
lock, and have become co-partners in the creation of a new 
being and a new soul to live forever, but who cannot com- 
plete the highest and noblest purpose of woman's creation. 
So repulsive does it present itself in this aspect that many 
who have advocated and performed it recoil from its repeti- 
tion upon the same woman. The renowned Meigs, 2 who 
had twice successfully delivered Mrs. Reybold, refused to 
incur the responsibility of a third operation ; Gibson subse- 
quently twice delivered her by Csesarean section of a living 
child, and she lives to-day in the ripeness of a happy old 
age in the enjoyment of two children and six grandchildren. s 

i Medical Times, March 10, 1883, p. 412. 2 Prof. Charles D. Meigs. 

3 Several of the subjects of Csesarean delivery have reached advanced life in the 
United States, the oldest known being sixty-eight and seventy-four years respectively. 



ESSAYS AND ADDRESSES. 227 

With such a showing it must follow that the operation is 
detestable where a living child is at stake. If so, is it entitled 
to a place among the scientific surgical procedures of the 
present time ? Does the fact that in a limited number of 
those cases where the mother's life only is in peril, an early 
and skilful performance secures a reasonable prospect of 
recovery, give it such a place ? Must this one fact, the only 
one in justification, and always embarrassed by the proba- 
bility of repetition, and the consequent variations in the 
chances of success, counterbalance the enormity of deliber- 
ately taking the life of the unborn? To admit this in the 
fulness of its import is to concede that intra-uterine life forms 
no part of the heritage of human existence, and that the vio- 
lent destruction of a new being just at the moment when 
nature has completed the processes which fit it for an inde- 
pendent life is a matter of such trivial concern that it can be 
determined upon the probabilities of enhancing the prospects 
of the woman's recovery. 

If craniotomy is justifiable, science and the good of man- 
kind demand that the limits of its application should be defi- 
nitely fixed. This question is now engrossing the attention 
of some of the ablest and most conscientious members of the 
profession. It cannot be disposed of by words or sentiment, 
but must be settled by an examination of the facts derived 
from an intelligent experience and an impartial study of the 
complications of labor and the methods of relief. 

It matters not whether craniotomy is or is not the most 
ancient of obstetric operations; in a scientific aspect all the 
other methods and procedures which have for their purpose 
the saving of the lives of both the mother and child must be 
regarded as its substitutes. These may be divided into intra- 
and extra-pelvic. Under the first must be classed delivery 
by the forceps, by turning, the induction of premature 

Several of the children have been heads of families, and one in this city [Philadelphia] 
is now forty-eight years old, and has given birth to eight children, three of whom 
have grown up.— Medical News, October 13, 1883, p. 411. 



228 ESSAYS AND ADDBESSES. 

labor, and symphysiotomy; under the latter, the Cesarean 
section and its substitutes, laparo-elytrotomy, the utero- 
ovarian amputation, and the total extirpation of the uterus, 
in all eight. The mere enumeration of this number of 
obstetric devices, and the constant and persistent efforts to 
improve and popularize them, constitute a reasonable pre- 
sumption of a widespread detestation of craniotomy ; and the 
present revival of interest in and discussion of the relative 
merits of the extra-pelvic methods, and their advantages over 
craniotomy, would seem to be conclusive against its continued 
acceptance as a scientific procedure, and relegate it to the class 
of desperate expedients, of doubtful propriety under any 
circumstances. 

According to Tyler Smith, about half of the cases of crani- 
otomy are occasioned by contraction of the pelvis. This esti- 
mate is too low. The great improvement in the forceps, and 
greater dexterity acquired in the execution of the intra-pelvic 
substitutes, have vastly lessened the field of application for- 
merly claimed for it, other than in cases of pelvic deformity. 
This, I believe, is now univerally conceded by competent 
authority. And, even in very many cases of faulty pelvis, 
to which, until recently, it was applicable, the better results 
to mothers now obtained by other methods have entirely 
excluded it. 

In the justo-minor or equally contracted pelvis it is inad- 
missible. In support of this statement I need only quote two 
recent authors. Lusk, in 1879, reported 1 a case in which 
the conjugate diameter measured, in the dried specimen, three 
and one-sixth inches ; craniotomy proved fatal. In his review 
of the subject he could find but five recorded cases of u gen- 
erally contracted pelves, in which the conjugate ranged from 
three to three and a quarter inches, and all died as a conse- 
quence of delivery through the natural passages." In the 
same paper he refers to the case of Korman, nearly identical 

1 Gynecological Transactions, vol. iv. p. 358. 



ESSAYS AND ADDRESSES. 229 

with his own, in which, " after more than three days' labor, 
the head adapted itself to the pelvis, and the child was deliv- 
ered alive by forceps. The mother died of peritonitis." Even 
in cases of such extreme general contraction nature and the 
timely application of the forceps have yielded better results 
than craniotomy. In discussing the proper management of 
such cases he says that laparo-elytrotomy, which had Keen 
recently revived by the " genius of Thomas and the daring 
of Skene," is peculiarly fitted to such conditions, and con- 
cludes with the assertion that, after a careful study, he is 
convinced that " where there is a diminution of nearly an 
inch in all the diameters, Csesarean section or probably 
laparo-elytrotomy holds out the best chances of success." 

Professor Isaac E. Taylor, in a masterly paper on the 
equally faulty or justo-minor pelvis, recently published, 1 
asserts that i ( in almost all the cases recorded of equally 
faulty or contracted pelvis, when the diminution is from 
three-fourths to one inch, both mother and child are lost." 
In considering the treatment he declares, with marked em- 
phasis, that the loss of lives of mothers by craniotomy and 
cephalotripsy in such cases, when the diminution is from 
three-fourths to one inch (and the total loss of life to the 
child, even in the minor degree of lessening of from one- 
third to one-half inch), is so disastrous that a conscientious 
discharge of duty demands the substitution of Csesarean sec- 
tion or some of its modifications, or symphysiotomy even in 
the minor degree of one-half inch. In the higher grades of 
contraction a more appalling presentation than by either of 
these operations could not exist. In the justo-minor pelves 
craniotomy is inadmissible. 

The most common form of deformed pelves is the simple 
flat, rickety or non-rickety, in which the faulty condition is 
mainly in the conjugate diameter ; hence it is usual to discuss 
the relative applicability of the various methods of treatment 

1 American Journal of Obstetrics, August, 1883, p. 811. 



230 ESSAYS AND ADDBESSES. 

with special reference to the measurements of the conjugate. 
There is not, perhaps, living to-day a single obstetric authority 
of accepted repute who will claim the practicability of crani- 
otomy in cases where the conjugate is one and a half inches 
or less. Indeed, but few hold it justifiable when the conju- 
gate is two and one-half inches or less. Parry, as early as 
1878, 1 demonstrated that in pelves with a conjugate of two 
and one-half inches or less, craniotomy gave no better results 
to mothers than Csesarean section. When the total number 
of lives at stake is considered, the results are vastly less favor- 
able than from Csesarean section, even when performed under 
disadvantageous conditions, for one-half of the lives are cer- 
tainly sacrificed by the murderous operation, and in those 
pelves where the conjugate is less than two and one-half 
inches Csesarean section is preferable whether the foetus is 
dead or alive. u As much as I have advocated," says Tay- 
lor, " craniotomy in preference to Cesarean section, in simple 
flat pelves, in my former papers on craniotomy and cephalo- 
tripsy, I am constrained to believe that one of the external 
operations, as the Csesarean section, or laparo-elytrotomy, 
early performed, or symphysiotomy when the labor is more 
advanced and the head wedged in the cavity, should be 
selected." In fact, in the light of recent experience and the 
improved results obtained from the intra- and extra-pelvic 
substitutes, professional opinion seems to be rapidly ap- 
proaching the definite conclusion that, when the conjugate 
is less than two and one-half or two and five-eighths inches, 
craniotomy is absolutely inadmissible. 

" As we have," says Montgomery, in a very able paper 
read before the Philadelphia County Medical Society, 2 "but 
three-fourths of an inch between three and twenty-five-hun- 
dredths inches, the maximum diameter at which craniotomy 
is supposed to be necessary, and two and one-half inches, the 
minimum diameter, in which it is safer for the mother than 



1 American Journal of the Medical Science, 1878, vol. lxxiv. p. 323. 

2 E. E. Montgomery : Medical Times, March 10, 1883, p. 387. 



ESS A YS AND ADDRESSES. 231 

Cesarean section, we have certainly reached a period when 
we are justified in abolishing the murderous operation of 
craniotomy from the list of elective operations when the 
foetus is still alive. " In the same paper, with equal ability 
and fairness, he discusses the relative advantages and merits 
of other alternatives, and reaches the following conclusions, 
which I accept in their entirety. These methods are equally 
safe to the mother, and afford the child a chance for life. 
They are suggested in the following order: Where the con- 
jugate measures three and one-fourth inches or over, the for- 
ceps; two and three-fourths inches or over, version ; two and 
three-eighths inches or over, symphysiotomy, followed, if 
necessary, by the forceps. In all subsequent pregnancies, 
and in the first when distortion is discovered sufficiently 
early, premature labor should be induced. 

I need not pause to portray the value of the forceps. Per- 
haps no other instrument ever invented has contributed as 
much toward the alleviation of suffering and saved so many 
lives. It is almost universally recognized as both a mother's 
and a child's instrument, and it is a significant fact that those 
who most frequently use forceps have least occasion to resort 
to either of the deadly expedients. The danger, if any, is not 
the result of their application, but of delay in using them. 

When the conjugate measures between three and one-fourth 
and two and three-fourths inches 1 version offers greater pros- 
pect of success than craniotomy. The mortality of version 
has been generally estimated at one in sixteen of mothers and 
one in three of children. This is believed to be too high ; 
but whatever it may be, it is in marked contrast to that of 
craniotomy, even when the latter is limited to like conditions 
of pelvic deformity or other causes of obstruction in which 
either is claimed to be admissible. The mortality in cases 
of version is not, however, due wholly to the method, but 
quite as often to the causes which indicate it, as in placenta 

1 In pelves whose conjugate ranges from 2.75 to 3.25 inches turning should he the 
initial step. — Goodell : American Journal of Obstetrics, vol. viii. p. 215. 



232 ESSAYS AND ADDRESSES. 

prsevia and rupture of the uterus, which may make it speedily 
imperative. 

The induction of premature labor offers a more decided 
antagonism to craniotomy, because it is specially applicable 
in those conditions of pelvic distortion in which the crani- 
otomist insist the latter operation is the proper elective pro- 
cedure. Its application lies within the limit of two and one- 
half inches minimum and three and one-half inches maximum 
measurement of the antero-posterior diameter. It is conceded 
that a viable child cannot be extracted through a pelvis with 
a conjugate less than the minimum, and that a living child at 
full term can be delivered through the natural passages with 
a pelvis measuring not less than three and one-half inches 
antero-posteriorly. Eitgen has constructed from the various 
measurements of the size of the head (quoted from Montgom- 
ery) at different periods of utenvgestation the following table 
showing the application of induced premature labor, after the 
period of viability, to various grades of pelvic deformity. He 
says labor may be induced at the 

29th week, when anterior posterior diameter of pelvis is 2" V" 
30thi " " " " " " "28 

31st " " " " " " "29 



35th 
36th 
37th 



2 10 

2 11 

3 



From statistics of artificially induced premature labor in 
cases of pelvic deformity, which I collated some years ago, 
when studying the value of the procedure in aggravated 
uraemia, I determined the maternal mortality at 5 T 2 ^y per 
cent., and that of children at 40 per cent. In these figures 
were included a large number of operations performed in the 
interest of the mother and under conditions which necessarily 
sacrificed the life of the foetus. With the improvement in 
the management of such cases greater safety has been secured 
to mother and child. 



1 Kiwisch says 2% inches conjugate is necessary for a viable foetus at 30th week to 
pass safely. 



ESSAYS AND ADDRESSES. 233 

It thus appears that the induction of premature labor 
covers the exact limits of pelvic obstruction and offers better 
results than craniotomy. It will, however, be said that, as 
a rule, it can only apply to second and subsequent pregnan- 
cies, because the incapacity will not have been discovered 
until labor has begun. This, unfortunately, is too true ; but 
it is not an argumeut against the induction of premature 
labor or in favor of the practice of craniotomy. It is simply 
proof of failure or neglect to ascertain the fitness of the preg- 
nant woman to give birth to a living child per vias naturales 
before it is too late to advise her, and to adopt the means 
science offers for the better protection of herself and her off- 
spring from the dangers incident to her condition. 1 

I must express my detestation and abhorrence of the wide- 
spreading vice of criminal abortion. I hold with that most 
eminent man and pious physician, the elder Hodge, that con- 
ception brings into existence a new being and an immortal 
soul, and that it is alike criminal in the mother and in the 
physician to employ means to destroy that being that sin and 
shame may be concealed or pride maintained. No reputable 
and conscientious physician will engage in or connive at the 
criminal production of abortion. Does the crime consist in 
the performance of the operation, in the effort to conceal vice, 
hide shame, prevent disgrace, obviate the discomforts of ma- 
ternity, or in the deliberate act of killing ? If in the latter, 
then tell me where the obligations of professional duty cease 
and crime begins ? To me abortion as a substitute is equally 
as reprehensible as craniotomy. It cannot, however, occupy 
a place among the conservative methods, for in those cases in 
which pelvic deformity will not afford a chance to a viable 
foetus craniotomy is conceded to be inapplicable. 

The revival of the invention of Sigault, by Professors 

1 There have heen as many as sixteen children sacrificed in the successive labors 
of one lady in this city [Philadelphia], each head having been locked in her pelvis, 
which was small but not deformed ; a seventeenth was saved, by an accident induc- 
ing labor, when she was eight months pregnant. — Harris : American Journal of the 
Medical Sciences, vol. lxxxv. p. 31. 



234 ESSAYS AND ADDRESSES. 

Morisani and Novi in the Neapolitan Hospital for Incurables 
has supplied another conservative procedure which promises 
most favorable results. Harris 1 informs me that in the last 
twenty-one years seventy-one operations have saved fifty-three 
women and fifty-five children. This result " is equal to that of 
early performed Csesarean section under favorable circum- 
stances. 7 ' It has been alleged that symphysiotomy, even when 
the pubic joint " was opened to the extent of three inches, with- 
out impairing or injuring the sacro-iliac joint, only three or 
four lines at most could be gained." This is true in regard to 
the antero-posterior diameter ; but the transverse and oblique 
diameters (Taylor, Harris) "are increased to the extent of 
one inch for the cavity and inferior strait." If the conju- 
gate is not materially lengthened, the cavity is greatly ampli- 
fied. 2 This amplification is what is needed to effect delivery 
in the class of pelvic distortions which have been considered. 
If necessary, delivery may be facilitated by the forceps. 3 In 
fact, symphysiotomy, premature labor, and the forceps may 
be combined, and the delivery of a living foetus accomplished 
without detriment to the mother. The pubic section is not, 
however, recommended when the conjugate is less than two 
and five-eighths inches, 4 and consequently does not cover the 
precise limits of three-fourths of an inch between two and 
one-half and three and one-fourth, in which its advocates 



1 Personal communication, December 22, 1887. 

2 In Naples the section is made subcutaneously -with the probe-pointed and sickle- 
shaped bistoury of Galbiati. An incision is made above the pubis, and the knife 
slowly passed behind the symphysis until it reaches the pubic arch, when the liga- 
ments are divided from below upward. The pelvis is not forced open, neither is the 
foetus turned or dragged upon, but when the head presents the case is left mainly to 
nature. In about one case out of four the forceps are applied. The incised part is 
treated antiseptically, and by irrigation if in warm weather. As soon as convenient 
the ossa pubis are kept in apposition by an immovable apparatus, to secure an early 
union of the severed parts.— Harris : loc. cit., p. 27 

3 In the new symphysiotomy of Naples version is 'never used, hence the escape of 
pelvic injury and the diminished foetal death-rate. 

4 In the cases reported, the conjugate ranged between three and one-quarter and 
two and one-half inches. Raffaele reports for Morisani a case operated on at the 
beginning of the eighth month, in which the conjugate measured only two and three- 
sixteenths. The patient, forty days after the operation, walked without incon- 
venience. Labor was artificially induced, and the woman delivered herself. 



ESSAYS AND ADDRESSES. 235 

claim that craniotomy is, par excellence, the elective opera- 
tion. 

If I should rest the argument here, it might be maintained 
that version, the induction of premature labor, and symphys- 
iotomy failed to supply sufficient opportunities for delivery 
between those limits separated only a fraction of an inch, and 
that craniotomy would be equally preferable in conditions of 
pelvic obstruction other than those caused by bony deformity, 
as in those cases where version or the forceps had proved in- 
effective. Its advocates cannot be permitted to cover retreat 
even under such ambiguous assumptions. The important 
and substantial improvements in the external methods leave 
it without justification even as an ultimate resort in these 
debatable conditions. 

The Caasarean section and its substitutes offer additional 
preferable procedures. The weight of the later and more 
recent authorities, other than the British, is vastly in favor 
of this operation when the conjugate is one and one-half 
inches or less. In fact, it cannot be said that craniotomy 
competes with it when the conjugate is two inches or less, 
and even when the measurement reaches two and one-half its 
performance is considered by some of its warmest adherents 
of doubtful propriety. 1 If the relative merits of the two 
methods are to be studied with impartiality, they ought to 
be measured by their respective results in like conditions of 
pelvic obstruction below the maximum conjugate at which 
either is admissible, and not by excluding from the mortality 
of craniotomy its disastrous results to mothers in the higher 
grades of diminution of the conjugate and the total loss of 
children at all grades. It does not subserve the purposes of 
science to limit one to an elective sphere of very narrow 



1 According to the investigations of Parry, whose decision I have verified by my 
own researches, craniotomy has scarcely a fractional advantage in saving life over 
gastro-hysterotomy in cases where the conjugate diameter of the superior strait 
measures two and one-half inches or less, and not even this claim when the latter is 
performed, as it should be, very early in labor.— Harris : American Journal of the 
Medical Sciences, vol. lxxvii. p. 46. 



236 ESSA YS AND ADDRESSES. 

proportions, where even its best results will not save 50 per 
centum of the lives imperilled, and compare such percentage of 
maternal recoveries with those obtained from Csesarean sec- 
tion and its substitutes extended over a far larger field and 
applied to less favorable conditions. But even this method 
of investigation does not present the external operations per- 
formed during the past five years in a less advantageous aspect 
than craniotomy. Harris has shown that when Csesarean 
section has been performed during the first twenty-four hours 
after labor has begun, 74 per cent, of women 1 were saved and 
81 per cent, of children delivered alive. Deufeillay (Lusk) 
has shown that in timely operations 81 per cent, of mothers 
are saved. In the Santa Caterina of Milan and the Krank- 
enhaus of Vienna (Harris) the Porro-Caesarean operation has 
saved 73 per cent, of women and all the children. The appli- 
cation of antisepsis has so greatly improved the results in 
other abdominal operations that no one can doubt that it will 
prove equally beneficial in these. This seems to have been 
already demonstrated by the immensely (Eustache) more 
favorable results to both mother and child which have been 
achieved in recent years. " The effects of antiseptic (Harris) 
measures and greater cleanliness have been shown by the re- 
sults of the Porro and other capital operations in large lying-in 
institutions, and in nothing more than the entire change of 
results in the two maternities of Naples, in which the old and 
the new pubic sections have been performed. Perhaps no 
tabular record of Italian surgery is so much to the point in 
exhibiting the possible variation of results from unfavorable 
to favorable as that prepared upon the first, second, and third 
hundred ovariotomies by Dr. Peruzzi. From having lost 
nine of the first operations in succession before achieving one 
success, they have gradually improved in results until now 
the mortality is reduced to a moderate percentage." 

1 Of the one hundred and thirty -two operations performed in North America prior 
to July, 1882, 495/u per cent, of women were saved.— Harris : Ibid., vol. xxxiv. 
p. 155. 



ESSAYS AXD ADDRESSES. 237 

Even when limited to the narrow area of its chosen field of 
election., craniotomy can never save the percentage of lives 
already obtained by gastro-hysterotomy and its modifications, 
nor can it ever attain the brilliant results of thePorro substi- 
tute, which for the whole number of operations has saved 45§ 
per cent, of mothers and 17^ per cent, of children. In fact, 
from a later classification by Harris (American Journal of the 
Medical Sciences, October, 1 883, p. 438), it appears that the 
Porro operation, carried out as originally designed, has saved 
46ti per cent, of the cases: the Porro-Miiller method, un- 
modified, has saved o'2\t per cent. ; and the two combined, 
482- 8 9 per cent, of women, and 90 out of 118 children. 1 In 
view, then, of the greater number of lives saved, and, in fact, 
when all the conditions and circumstances are impartially con- 
sidered, the greater number of mothers saved, the classical 
Cesarean section, and its modification and substitutes, must 
be regarded as conservators of life. But this is not all ; 
Cesarean section may restore to women incapacitated by 
pelvic deformity the privilege and power of giving birth to 
an indefinite number of living children. Lungren 2 has shown 
that in one hundred and nineteen multiple operations upon 
forty-eight women there were only eight mothers lost. In 
three of these cases the operation was performed seven times, 
in two six times, in one five times, in three four times, and 
in three three times, all of which recovered. The Porro 
modification has not only saved a larger percentage of lives, 
but prevents subsequent pregnancies, and therefore in such 
cases there cannot occur such successive repetitions of crani- 
otomy as related in the case before cited. In the face of such 
facts, can the most enthusiastic craniotomist continue to class 
the operation among the elective procedures ? 3 It has been 

1 The Sanger operation in Europe saved forty women and forty-eight children out 
of the first fifty, in chronological order, and the Porro twenty-one. in fifty, — Harris : 
Personal communication,. December 22, 1887. 

2 American Journal of Obstetrics, vol. xiv. p. 78. 

3 Keyser estimates the mortality from second operations on the same woman at 
29 per cent. ; in the United States it has been 25 per cent.— Harris : American Journal 
of the Medical Sciences, vol. lxxii. p. 61. 



238 ESSAYS AND ADDRESSES. 

alleged that in occasional instances women have after one 
craniotomy given birth per vias naturales to living children, 
and such is probably true j but it only proves that either the 
operation was hasty and unnecessary in the first pregnancy, 
or that the obstruction was due to disproportion of the foetal 
head or to impaction of the foetus in a transverse position. 
The rule is that each subsequent foetus has been killed and 
mutilated, as in the case cited by Harris (see note, page 233), 
or one of the external operations has been finally resorted to, 
as in the case of Mrs. Reybold, with equally satisfactory 
results. 1 

It is not necessary in this connection to discuss the relative 
merits of the classical Cesarean section and its substitutes, 
nor to point out the indications which should give one or the 
other the preference. Garrigues, 2 Harris, and others have so 
fairly and ably reviewed these questions that, even if relevant 
to the present issue, I could afford to pass them with this 
reference. 

2Tor is it necessary that I should review in detail the 
comparative merits of craniotomy and its alternatives in the 
minor and rarer forms of obstruction to labor. In the very 
rare forms of pelvic distortion, as in the oblique-ovate, the 
Csesarean section is generally most strongly advocated. The 
time has probably passed when anyone would hold crani- 
otomy on the living foetus justifiable in cases of cancer of the 
cervix uteri or advanced phthisis. The results in either case 
are equally, if not more, favorable when left to nature un- 
aided, or, at most, assisted by the forceps or version. In 
transverse positions Harris has shown that in the United 
States twelve Csesarean sections have yielded nine suc- 
cesses. But neither cancer, malacosteon, exostoses, nor uterine 
fibroids contraindicate Cesarean section or its substitutes. In 



1 We have had women in this country who have endured several hours of suffering 
under craniotomy, and narrowly escaped with their lives, who were afterward 
delivered safely of living children by gastro-hysterotomy.— American Journal of the 
Medical Sciences, vol. lxxvii. p. 59. 

2 American Journal of Obstetrics, vol. xvi. p. 337. 



ESSAYS AND ADDRESSES. 239 

pregnancy complicated with fibriod tumors of the uterus it has, 
however, proved very unfavorable in this country, because 
of the attending exhausting hemorrhage ; yet in some it is 
not only the best but the only possible operation (Garrigues), 
as in Sanger's case, where a fibroid as large as a child's head 
sprang from the posterior wall of the cervix. 

Professor G. Eustache (Lille, Belgium) concludes a paper 
on the " Parallel between Embryotomy and the Cesarean 
Section," read before the London International Congress, as 
follows : " Considering, on the one hand, (1) the recent re- 
sults of ovariotomy and of all other abdominal sections; (2) 
the improvement in the prognosis of all surgical injuries 
under antiseptic treatment ; (3) the success of Porro's opera- 
tion ; (4) the immensely favorable results both to mother and 
child after the Csesarean section, which have been published 
during recent years." 

" And considering, on the other hand, that embryotomy, 
while it always sacrifices the child, exposes the mother to as 
grave dangers as the Cesarean section ; that it is inapplicable 
in many cases of deformed pelvis, e.g., when the conjugate 
is five centimetres and under." 

"L When the child is living at the beginning of labor, 
and when the pelvic strait is under 78 mm. — the extreme 
limit for the application of the forceps — the Cesarean opera- 
tion should be performed early ; that is to say, as soon as 
labor has really set in, and with antiseptic precautions." 

" II. When the child is dead and the superior strait meas- 
ures five centimetres recourse should be had to embryotomy. 
Below five centimetres the Csesarean section becomes an opera- 
tion of necessity." 

" To sum up, the Cesarean section should be the method 
of election, embryotomy that of exception." 1 

Harris 2 struck the key note of success when he wrote 6 ' that 
the first and most important step is to make the operation one 

1 Ibid., vol. xiv. pp. 944, 945. - Amer. Journ.iMed. Sci., vol. lxxxiii. p. 374. 



240 ESSAYS AND ADBBESSES. 

of anticipation and choice, rather than one of dire necessity 
and last resort. " The largely increased percentage of recov- 
eries in the timely operations has demonstrated beyond dis- 
pute that delay is the chief factor of danger. The exhaustion 
of the patient and bruising of the soft parts by long-continued 
ineffectual efforts to accomplish delivery through the natural 
passages have, in very many cases, destroyed every prospect 
of recovery before the operation was begun. "A very early 
operation (Harris) in the United States will save three out of 
four women and as rnany children ; a moderately late one will 
lose about two out of three, and one-half the children ; and a 
very late operation — that is, from three to fifteen days or more 
after the commencement of labor — will lose three, four, or five 
to one, according to circumstances.'' 1 The application of an- 
tisepsis, 2 improvements in the method of operating, manage- 
ment of the uterine wound, and subsequent treatment of the 
patient have contributed largely to the better success. And 
to-day the prospect is so encouraging that even the most 
skeptical will soon be compelled to accept the results as 
conclusive. 

So much for the obstetric and surgical substitutes for crani- 
otomy. There is another plan of treatment even more con- 
servative than either of the procedures heretofore considered. 
Nature, says Lusk, 3 will, under favorable circumstances, in 
all but the extreme forms of pelvic contraction, (i do her own 
work with the least expense of infant life, and with a relatively 
small maternal mortality." He cites the fact that, in cases 
of contracted pelvis in the Dresden, Leipsic, and Breslau 
Maternities, ' ' four hundred and seven spontaneous deliv- 
eries took place with the loss of fifty-three children, and, 
from puerperal diseases, of twelve mothers, the latter repre- 
senting very nearly the usual mortality in lying-in hospitals." 
By favorable circumstances he means a " presentation and 

1 Amer. Journ. Med. Sci., vol. lxxvii. p. 62. 

2 Garrigues : American Journal of Obstetrics, vol. xvi. p. 508. 

3 The Science and Art of Midwifery, p. 476. 



ESSAYS AND ADDRESSES. 241 

position of the child's head suited to the form of the pelvis, 
and a sufficient degree of uterine activity." I have previ- 
ously incidentally referred to unnecessary and hasty cranioto- 
mies and to the dangers of delay in the performance of its 
substitutes. These can only be avoided by a careful and 
accurate study of the existing conditions, based upon a com- 
plete knowledge of the obstacles presented and applicability 
of the methods of procedure. The wisest course will always 
yield the best results, but when to interfere and how to pro- 
ceed are not always either easily or quickly determined. 
Human judgment, even when supported by intelligent expe- 
rience and the highest scientific attainments, is not infallible. 
The expectant plan of treatment is not mere guesswork or 
the haphazard conclusion of the tyro, but the deliberate judg- 
ment of one who knows what not to do as well as what to 
do and when to do it. It is not the sloth of idle expecta- 
tions, but the masterly inactivity of experience, discretion, 
and knowledge. 

But, after all, the question hangs upon the right of elec- 
tion between two lives at stake. Just so long as this right is 
maintained just so long craniotomy will have its advocates 
and operators. The law of justification will always be in- 
voked to cover the plea of necessity. If the life of the 
mother could certainly and only be saved by the killing 
of her foetus, and the death of both was otherwise inevitable, 
the execution of the child might be justifiable as the only 
alternative. But no such relation of conditions ever did or 
can exist. Unless delivery is accomplished, both lives will 
be sacrificed, but the killing of the foetus is not necessary to 
and does not guarantee the recovery of the mother. Neither 
are the two lives in equal danger. Either may be saved with 
or without the saving of the other. Craniotomy offers no 
chance to the foetus, but a reasonable prospect of recovery to 
the mother. Its substitutes offer three out of four chances 
to the foetus, and quite equal, or, at most, but slightly les- 
sened chances to the mother. Then it must follow that this 

16 



242 ESSAYS AND ADBBESSES. 

right of election subordinates the life of the foetus and the 
larger number of lives to the possible enhancement of the 
chances of life to the mothers, and relegates the resources of 
obstetric science, which offer in the aggregate largely more 
favorable results, to the category of methods of dire neces- 
sity and almost hopeless resort. It is uot, then, the greatest 
good to the greatest number, but the offer of possibly im- 
proved prospects to the chosen few. Is that the humanity 
which the science of mediciue should espouse and proclaim to 
the world as an illustration of its beneficence ? 

This right of election is furthermore based upon the alleged 
greater value of the life of an adult woman than that of her 
unborn child. By whom, and in what manner, is this valu- 
ation to be estimated? Is it a mere matter of trade and 
business, to be determined always in favor of one because the 
future and possibilities of the other cannot be known ? Are 
social position, personal qualities, and domestic relations com- 
modities of value to be purchased at the cost of the life of the 
unborn ? But it so happens that one such life would rarely 
liquidate such indebtedness. If the right to take life on such 
a pretext is indisputable, the number of such sacrifices can 
only be determined by the number of subsequent pregnan- 
cies, and the breeding and killing may go on at the pleasure 
of the woman and will of the executioner. Even the most 
uncompromising advocate of the murderous operation could 
not view such a picture without the utmost abhorrence. 

The relative value of two lives cannot be the only arbiter, 
for every life is of equal value to every holder. It is true 
that the foetus has not gained an independent existence. It 
is, nevertheless, true also that in these cases it is the life of a 
woman who cannot give birth to a living child per vias natu- 
rales. And such incapacity is the one and only claim of right 
to destroy the foetus. Can such a right rest exclusively upon 
such a basis, when it is established that other procedures offer 
almost, if not quite, equal chances of the mother's recovery, 
and rescue the larger number of children imperilled ? 



ESSAYS AND ADDRESSES. 243 

It is, moreover, claimed that a mother's life is above and 
beyond any and every consideration of a foetus in utero. A 
specious subterfuge ! But very few, if auy, such women 
could ever become mothers unless the delivery of a living 
child is accomplished by one of the conservative methods. 
Not one of the forty women cited by Lungren could ever 
have had a child to foster or could ever have experienced 
the first pleasure of a realized maternity but for the Cesarean 
section or one of its substitutes ; and the woman who had 
submitted sixteen foetuses to destruction might have added 
one or more but for the timely accident which Providence 
interposed as its expression of abhorrence. 

It is also alleged that the law of moral responsibility im- 
poses the obligation of professional duty to destroy the foetus 
that the chances of the woman's recovery may be improved. 
In timely Caesarean sections 74 per cent, of women and 80 
per cent, of children ; in the recent Porro-Csesarean operation 
73 per cent, of mothers and all the children have been saved; 
and in the first fifty Sanger operations 80 per cent, of mothers 
and 96 per cent, of children have been saved. These results 
are comparable with 80 per cent, of recoveries of women and 
loss of all the children after craniotomy. It may be that if 
the comparisons were based upon the results of craniotomy 
during the last few years it would be less unfavorable. Surely 
such a law or duty cannot find its vindication in these data, 
and its supporters must seek some other defence than results. 
If such a law or rule of conduct has any foundation at all, it 
is the unwritten ipse dixit of by -gone periods — the outgrowth 
and excuse of a dire necessity, which science never did accept 
and can no longer tolerate. 

The beneficence of medical science consists in the alleviation 
of suffering and the prolongation and saving of life. In the 
face of the facts hereinbefore presented there can be no rule 
of morals or of duty which clothes it with the prerogative to 
take life as a mere choice of obstetric or surgical procedures, 
and this, too, when such choice incurs the responsibility of 



244 ESSAYS AND ADDRESSES. 

its repetition, while another operation might have either pre- 
vented any subsequent pregnancy or fitted her to bear living 
children independent of her physical incapacity. 

If more attention was paid to the saving and more regard 
held for the life of the foetus, more women would be saved. 
The dangers of delay would be avoided and the life of the 
foetus would not be lost in ineffectual and unskilful efforts to 
accomplish delivery of a living child through the natural 
passages when the obstruction precluded its possibility. It 
would demand an early diagnosis of the condition, and in- 
voke a more minute and more general study of the causes of 
obstructive labor and the proper methods of procedure. The 
sentiment of a higher responsibility would be infused, and 
the pride and glory of saving two lives would oftentimes 
supplant the detestable act of killing one and possibly losing 
both. 

In conclusion, I disclaim any assault upon individual 
opinion or practice. I have endeavored to consider the 
question in its scientific aspect, and entirely free from the 
influence of eccelesiastical doctrines. I fully realize the 
embarrassment of individual cases when a professional 
brother may be dizzied by the emotional appeals of a false 
and sentimental humanity and his judgment made to swerve 
from a sound discretion and logical conclusions to the adop- 
tion of a plan of treatment which the experience of past ages 
has handed down to us, and vindicated by the assertion of 
the right to take one life rather than leave two to die. But, 
in the interest of a broader humanity and a far wider field of 
usefulness, I would follow the pathway illumined by science 
and supported by the results of recent progress, and offer 
chances to two lives rather than take the one which cannot 
assure the safety of the other. 



ESSAYS AND ADDRESSES. 245 



PEASES ET RECTOR. 

ALMJl UNIVERSITATIS SANCTIS MARLE BALTIMORENSIS 

OMNIBUS ET SINGULIS PR^ISENTES LITTERAS IN- 

SPECTURIS PACEM ET SALUTEM IN DOMINO. 

Cum in optimarum artium studio, non secus ac in exequen- 
dis muneribus, illos dignitate antecellere congruat, laureaque 
decorari quos majorum laborum assiduitas insignes reddidit, 
Alma Universitas, pro concessa Sibi anctoritate, communibus 
votis dignum oinnino judicavit quern inter Doctores in jure 
adscriberet D. Samuelem Clagett Busey, jam medicinse 
Doctorem celeberrimum. Qui, dum indefessa cura,in allevian- 
disc urandisque infirmorum morbis, per multos annos incum- 
bered moralibus disciplinis adj amenta ex physiologicis scientiis 
contra pessimam craniotomiaa praxim mimistravit. Sic ver 
egregiusse, ternseque supremse Legis principia optime cal- 
lentem se exhibuit, eademque luculenter exposnit et strenue 
propugnavit, probe intelligeus artem medicam cum altioribus 
naturalis divinique juris principiis ultime conjungi, imo ab 
illis pendere. Quae quidem omnia quum certissime non solum 
fama referente, sed etiam propria nostra cognitione evidenter 
constent, laudatum D. Samuelem Clagett Busey, unan- 
imi Almse Universitatis Professorum suffragio, Doctorem. 
In Jure renunciamus, collatis eidem omnibus honoribus ac 
privilegiis, quibus caeteri Doctores rite promoti potire consue- 
verunt. 

In cujus rei testimonium prsesentes litteras chirographo 
nostro in majori sigillo Almse Universitatis munitas expediri 
curavimus. 

Datum in iEdibus Universitatis Sanctse Mariaa Baltimoren- 



246 ESSAYS AND ADDRESSES. 

sis, die VI, niensis Januarii anno reparatse Salutis, MDCCC- 
LXXXVIII. 

A. Magxiex, S.S.,S.T.D., 



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£> 


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3 


bd 


SI 
4 






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St. Mary's Seminary, North Paca Street, 
Baltimore, Md., January 13, 1888. 

Dr. Samuel C. Busey. 

Dear Doctor : It gives me and the professors of St. 
Mary's University great pleasure to confer upon you the de- 
gree of Doctor in Law. 

Your well-known merit, your science and zeal in the pro- 
motion of good morals and the sound principles of Divine 
and natural law in your profession as a medical doctor, have 
won for you the esteem and even admiration of many, and 
principally of the Catholic clergy, whose high mission you so 
well understand, and have constantly seconded with much 
success. 

Believe me, dear Doctor, 

Your devoted and obedient servant, 

A. Magxiex, S.S., D.D. 

1545 I Street N. W., 
Washington City, January 14, 1888. 

To the President and Professors of St. Mary's 
University. 
Reverend Fathers : I beg that you will accept my 
grateful acknowledgment of the distinguished honor you 



ESSAYS AND ADDBESSES. 247 

have conferred upon me by decorating me with the degree 
of LL.D. 

This high distinction comes to me, as stated in the diploma, 
for the maintenance of convictions which were the result of 
considerations entirely free from ecclesiastical influence, and 
is the more valued because of the independent act of the 
Faculty, the members of which are personally unknown to me. 

The convictions referred to relate to the obligations of phy- 
sicians to save life, and the belief that science and religion 
are not antagonistic. My abhorrence of the operation of 
craniotomy induced me to review this subject in its scientific 
aspect, and, when the conclusion which you so heartily ap- 
prove had been reached, duty compelled me to promulgate it. 
This announcement invoked the adverse criticism of many 
physicians which I have borne in silence and without remon- 
strance until now. I have the gratification of knowing that 
my indorsers are now more numerous than my censors. 

The St. Mary's University is the first institution of learn- 
ing to approve publicly my course. 

Please, also, accept the expression of my appreciation of 

the graceful and complimentary terms which you have chosen 

to convey to me the action of the Faculty over which you 

have so long presided with such dignity and honor to yourself 

and associates. 

Yours, very truly, 

" S. C. Busey. 



ADDEESS OF WELCOME 

TO THE AMERICAN GYNECOLOGICAL SOCIETY, DELIVERED 
AT WASHINGTON, SEPTEMBER 22, 1885. 

Mr. President and Fellows : I offer you the greetings 
of fellowship, and bid you welcome guests of the Washington 
Obstetrical and Gynecological Society. The acceptance of 



248 ESSAYS AND ADDRESSES. 

the invitation to hold your tenth annual meeting in this city 
and your presence here to-day confer a distinguished honor 
upon our young Society, now just completing its third year of 
existence, and affords an opportunity for its members to meet 
and make the acquaintance of men who, by their brilliant 
achievements in the sciences of obstetrics and gynecology, 
have won world-wide reputations, and added lustre and re- 
nown to American medicine. 

We extend to you the hospitalities of fraternity, and, by 
our presence at this opening session, attest our professional 
regard and obedience to parental precept and authority. 

It is a special gratification to know that the youngest of 
your natural offspring will enjoy the honor of commemora- 
tive union on this tenth anniversary of a Society which, in the 
past decade, has contributed so much to the advancement of 
obstetrics and gynecology, and to the cure and alleviation of 
the afflictions of woman. 

On the roster of Fellowship the names of Atlee, Bucking- 
ham, Peaslee, Sims, Trask, Wallace, and White are marked 
with the asterisk of death. Others have come to fill the places 
of the lamented dead, and the future gives promise of even 
greater progress and higher excellence in the aims of conscien- 
tious and scientific medicine. 

Then here, at the nation's capital, on this auspicious occa- 
sion, in the unity of a common purpose, let us join with you 
in that faith and devotion to duty which have been crowned 
with such marvellous success and rich rewards. You must 
lead ; we will follow. And, when you have completed the 
labors of the present meeting, and the new and renewed friend- 
ships shall be interrupted by your return to the scenes of your 
daily work, if our gratitude as pupils shall be the measure 
of your pleasure as instructors, your second advent will not 
await the expiration of another decade. 



ESSAYS AND ADDRESSES. 249 



THE HYGIENE OF PREGNANCY. 

DELIVERED BY THE PRESIDENT OF THE WASHINGTON 
OBSTETRICAL AND GYNECOLOGICAL SOCIETY, 
. OCTOBER 2, 1885. 

In a recent contribution 1 I expressed the opinion that the 
natural laws governing the childbearing life of woman should 
constitute safer guides for the sanitation of pregnancy than 
the artificial methods which necessity and experience have 
invoked. I did not, however, mean to undervalue the expe- 
dients and procedures which medical skill and science offer to 
prevent, mitigate, and cure the diseases of pregnancy. Whilst 
I maintain that these laws should constitute the fundamental 
basis of any code of hygiene that will attain the highest aim 
in the prevention of the diseases of pregnancy, reduce the 
mortality of childbearing to its minimum, and promote the 
longevity of post-cessation life, I am compelled to admit the 
impossibility of their general enforcement. The duty, then, 
devolves upon the profession to devise other methods of con- 
servation of the lives of pregnant women which, if not the 
best, will secure the best results human skill can reach. 

For convenience, I limit the hygiene of pregnancy to the 
preservation of the health of woman during those periods of 
her life beginning with conception and terminating with the 
commencement of labor. This is an arbitrary limitation, 
for it cannot be technically asserted that pregnancy is con- 
cluded until the womb is completely evacuated of foetus and 
secundines. It excludes also the diseases of intrauterine life. 
The preservation of the health of the mother so constantly 
and directly refers to the health and life of the foetus that it 
must necessarily follow that the hygiene of pregnancy will 

1 Gynecological Transactions, vol. x. p. 8. 



250 ESSAYS AND ADDRESSES. 

comprehend, to a certain extent, the hygiene of the foetus ; but 
only so far does it relate to the diseases of intrauterine life. 

The changes, consequent upon pregnancy, which take place 
in the general organism, glandular system, and generative 
organs are physiological. Pregnancy is not a disease, yet 
the laws of diagnosis have, as yet, failed to define the limits 
where the physiological ceases and the pathological begins. 
The structural changes and formative activity establish con- 
ditions susceptible of easy and sometimes rapid and insidious 
transformation into morbid process. They invite and present 
the opportunity for the detrimental influence of trivial and 
extraneous agencies. It is not, therefore, surprising that the 
acquired causes of the diseases of pregnancy should be so 
numerous and multifarious. 

The virgin uterus measures but sixteen square inches in 
superficial area; the pregnant womb, at term, three hundred 
and forty. The textural changes which take place involve 
every constituent tissue of the organ. The constantly increas- 
ing superficial area, weight, and dimensions of the pregnant 
womb take place in a cavity supposed in a normal condition 
to be always full. This cavity is enclosed, for the greater 
part, with walls possessing great expansile and elastic proper- 
ties; nevertheless, especially in primiparse, the mechanical dis- 
turbances of its contents are manifold and, oftentimes, seri- 
ous. The cavity is filled to repletion and its walls stretched 
to their utmost tension. The neighboring viscera are displaced 
and compressed. The movements of respiration are inter- 
rupted. The thorax is diminished in depth and increased in 
breadth. Vital capacity is lessened. The portal circulation 
is disturbed. The arterial and venous blood-currents in the 
vessels in the abdominal cavity and lower extremities are ob- 
structed ; as a consequence there are " superior arterial hyper- 
emia and inferior venous hyperemia " (Barnes). Thus local 
congestions may be determined. The complex processes of 
digestion, nutrition, and elimination, in some one or more 
respects, may be impeded, impaired or perverted. The 



ESSAYS AND ADDRESSES. 251 

peristaltic movements of the intestinal tract are so constantly 
lessened with the increasing volume of the uterus that consti- 
pation, more especially during the latter months of pregnancy, 
is a common and troublesome complication. In consequence 
of the diminished capacity of the bladder micturition is more 
frequent and annoying. These disturbances of the functions 
of the organs and auatoraical relations of the parts, caused by 
the presence and continuous growth of a vascular and highly 
organized tumor in a closed cavity, lined by an acutely sensi- 
tive membrane, stretched in various parts to its utmost tension, 
would seem to present a variety of conditions favorable to the 
development of disease. This danger is vastly augmented 
by the constantly increasing afflux of blood to, and the exal- 
tation of nutritive and formative activities in, the uterus and 
genitalia. 

The changes which take place in the constitution of the 
blood approach, even more closely, pathological conditions. 
The red corpuscles, albumin, iron, and salts are diminished. 
The white corpuscles, fibrin, and water are increased. With 
the increase in volume there are increasing impoverishment of 
the blood and loss of the carriers of oxygen. Consumption 
and waste, and elimination of carbonic acid and urea are aug- 
mented with diminished ingestion and assimilation of food. 
Cell-nutrition and metamorphosis are consequently deranged. 
With the increase of water and fibrin and loss of albumin, a 
condition of serous plethora and hyperinosis is established, 
which favors transudation, coagulation, and thrombosis. 

Not less important are the dynamic changes in the circula- 
tion. With hypertrophy of the heart there are dilatation of 
its cavities and increased arterial tension. It may be that 
these dynamic changes are compensatory and not resultant. 
They coexist with lessened vital capacity, diminished oxy- 
genation, increased blood-mass, blood-degradation, and hyper- 
inosis, with increased liability to coagulation. 

The blood and circulatory changes begin and progress con- 
sentaneously with the nutritive and developmental processes 



252 ESSAYS AND ADDRESSES. 

taking place in the generative organs. With the rapid growth 
and increasing demand of the new being for sustenance there 
is progressive waste with lessened food-supply. With the 
augmentation of blood-mass there are anaemia, diminished 
oxygenation, and increased propulsive power of the circula- 
tory apparatus. 

The changes which take place in the glandular system are 
equally interesting and no less remarkable. Probably all the 
glands undergo some change, due, perhaps, to the increased 
work imposed upon them. The thyroid gland and spleen are 
usually enlarged, the latter sometimes very much so. The 
thyroid enlargement may have some connection with the 
hypertrophy of the heart and increased arterial tension. The 
condition of the spleen would seem to be directly connected 
with the blood-changes. They may be conservative processes, 
but are closely allied to certain pathological conditions. 

The most notable gland-changes are those which occur in 
the secretory and excretory glands. The salivary glands, the 
glands of the uterine neck, the sebaceous and sudoriparous 
glands, and those of the stomach, all, to a greater or less ex- 
tent, varying with individual peculiarities and susceptibilities, 
undergo functional and organic change. These modifications 
of gland structure and function may be the physiological out- 
growths of the circulatory disturbances, increased nerve-irri- 
tability, and extraordinary activity of the nutritive energies. 
Turgescence is a common factor, and increased secretion a 
common result. They are probably eliminative and compen- 
satory conditions, but why should they vary so much in differ- 
ent women, and in the succeeding pregnancies of the same 
woman without apparent cause ? As a rule, the increased 
secretions are simply the physiological result of glandular 
activity. Excessive salivation, uterine hydrorrhcea, and the 
vomiting of unusual quantities of fluid must, however, be 
considered pathological. 

The changes which take place in the mammary glands 
are developmental. Milk is the natural aliment of young 



ESSAYS AND ADDRESSES. 253 

animals. Maternal lactation is the natural method of supply- 
ing it to the infant. The secretion of milk is the ultimate 
product of those changes in these glands which begin with 
pregnancy and are completed during the earlier days of the 
puerperium. Lactation begins with the birth of the offsprings 
and continues for an indefinite period. The function is not 
suddenly established, nor does it suddenly subside. The 
periodical evolution of the breasts corresponds with the pro- 
gress of pregnancy. Both processes are gradual. The grad- 
ual subsidence and cessation of the function of milk-secretion 
should correspond with the gradual involution of the gland- 
structure and its return to a state of quiescence and dimin- 
ished size. With the recurrence of pregnancy the process of 
evolution and functional activity is reawakened. No other 
organs of the body, except the uterus and ovaries, are sub- 
jected to similar periodical changes. As the uterus and ovaries, 
so likewise the mammary glands, when the period of sexual 
involution begins, undergo those changes which finally termi- 
nate glandular activity. The processes of periodical evolu- 
tion and involution are in inverted parallelism. The former 
is as necessary to promote the secretion of milk as the latter 
is to restore the gland to a normal quiescent condition, to 
await rehabilitation and renewed functional activity with suc- 
ceeding pregnancy. To the functional irregularities and 
derangements caused by artificial interference with these phys- 
iological processes must be traced many of the tumor diseases 
to which these glands are so liable. 

Several years ago, when engaged in the study of the dis- 
eases of the lymphatic system, I suggested that the cicatrices 
and pigmentations of pregnancy were due to disturbances of 
the lymph-spaces. Subsequently I demonstrated that the 
cicatrices were dilated lymph-spaces of the corium. Since 
then Creighton has verified my suggestion in regard to pig- 
mentation. These pigmentations are due to the deposition 
in the lymph-spaces and other lymph-structures of the waste 
products of evolution. The discoloration of the areolae of 



254 ESSAYS AND ADDRESSES. 

mammary glands is one of the earliest signs of the evolution, 
and the latest to disappear in the involution of the glands. 
It is the result of the deposit of pigment-granules in the con- 
nective-tissue spaces. Granular pigmented cells are also found 
within the secretory acini and in the lymph-spaces of the sub- 
jacent lymphatic glands. The pigmentations in other locali- 
ties are, probably, similar depositions of the waste-products 
of tissue-changes taking place in adjacent and neighboring 
parts. 

The lymphatic structures of the mamma? are essential ap- 
pendages of the secretory apparatus of the glands ; and in the 
breasts, as elsewhere throughout the body, are the receptacle 
of the redundant elements and products of nutrition. The 
absorption and disposal of these products and their elimina- 
tion and utilization are the special functions of the lymphatic 
system. These processes are very active daring pregnancy. 

Physiological leucocytosis is one of the characteristic phe 
nomena of pregnane}^. Virchow was the first to call atten- 
tion to the fact that these periodical excesses of white corpus- 
cles in the blood were not due to changes taking place in the 
blood itself. They are mainly the product of irritation of 
the lymphatic glands. He says : " In proportion as preg- 
nancy advances, as the lymphatic vessels of the uterus dilate, 
and the interchange of material in the organ increases with 
development of the foetus, the lymphatic glands in the inguinal 
and lumbar regions become enlarged, and sometimes to such 
an extent that, if we were to find them in a similar state at 
any other time, we should regard them as inflamed. This 
enlargement conveys into the blood an increased quantity of 
fresh particles of a cellular nature, and thus from month to 
month the number of colorless corpuscles augments. 7 ' The 
lymphatic structures of the pelvic region must be the chief 
source of the leucocytosis of pregnancy ; but with Creighton 
we " must believe that the abundant cellular waste-products 
of the breasts contribute to that condition." 

The disposal and utilization of the unused and waste 



ESSA YS AND ADDRESSES. 25 5 

products of secretion are part of the marvellous phenomena of 
pregnancy. The lymphatic system is the laboratory in which 
these materials are reprepared for future nutrition. The 
increased burden imposed upon it excites new and augmented 
activities. It seems to occupy the relation of an intermediary, 
completing the physiological process and protecting the organ- 
ism from pathological conditions. But as organs of reception, 
nitration, elaboration, and conveyance, the lymph-glands and 
structures may become foci for the generation and diffusion 
of disease. 

The liver and kidney have increased work to do during 
pregnancy. Trousseau and several other observers have in- 
sisted that the liver was enlarged. It supplies the bile, which 
is an essential element of digestion. It is also an excremental 
organ, insomuch as it receives the blood from the portal sys- 
tem which is charged, in a part at least, with the products of 
augmented blood-supply to the pelvic organs and of the enor- 
mous developmental work which takes place in that region. 
The portal blood must be loaded with these excremental mat- 
ters, and greatly increased duty must, consequently, be imposed 
upon the liver. As an emunctory, the liver is usually equal 
to the emergency ; but this function must be supplemented by 
the increased eliminative capacities of the skin, lungs, and 
kidneys. In health these organs preserve their compensatory 
activities, but ineffective power in either may lead to accumu- 
lations in the blood which will poison the entire organism and 
produce disastrous results. The lungs eliminate carbonic acid ; 
the skin dissipates animal heat, and excretes water, urea, and 
salts ; but the kidneys are the chief emunctory glands. Upon 
them devolves mainly the elimination of the useless and pois- 
onous products of secretion and tissue-change. They have no 
recrementitial function to execute. Through them the waste 
is finally discharged. This office is a relentless necessity. 
The compensatory organs are absolutely inadequate to assume 
the duty and maintain health. During pregnancy the work 
is vastly increased, and a larger quantity of abnormal elements 



256 ESSAYS AND ADDRESSES. 

find their way into the urine. With the progress of utero- 
gestation the more urgent is renal elimination, and the more 
imminent the danger of disturbance of the function. 

I need not now detain the reader with a recital of the path- 
ological phenomena of the albuminuria of pregnancy ; but I 
cannot permit the occasion to pass without impressing upon 
him the importance of early recognition of the initial sign of 
its presence. I have more than once expressed the opinion 
that puerperal eclampsia and its lamentable consequences were 
too often attributable to neglect. I hold that the pregnant 
woman should be under continuous observation of a competent 
physician ; and when such is the case, he is responsible for 
the occurrence of avoidable disease. I believe, furthermore, 
that if such observation were diligently and intelligently pur- 
sued, the cases of eclampsia would be greatly diminished, and 
the mortality would be reduced to its minimum. 

I venture to call attention to another circumstance too often 
forgotten. More women die of renal disease during the period 
of child bearing life than men of the same age. The ordinary 
result of complete recovery from puerperal nephritis after 
delivery is too often accepted as inevitable, aud the patient is 
discharged without even an admouition of the peril which 
may hasten her untimely death. 

I will remind you also of the physiological relationship 
and reciprocal dependency of the excretory fuuctions of the 
lungs, skin, intestinal tract, and kidneys. Disturbance of this 
close connection may speedily develop grave disorder. 

Until recently, the appearance of albumin in the urine was 
universally held to be the symptom of threatening danger, 
notwithstanding the facts that in very many cases no grave 
complications occurred ; and in many other cases, even 
when the symptoms denoted serious lesions of the kidneys, 
all traces of disease speedily and spontaneously subsided 
after the evacuation of the uterus. There can no longer be 
any doubt that albumin does appear in the urine during 
health as a physiological phenomenon ; but whether such a 



ESSAYS AND ADDRESSES. 257 

condition is ever present during pregnancy is yet a mooted 
question. 

Physiological albuminuria has been ascribed to various 
causes. The presence of albumin in the urine of the new- 
born has been attributed, by Ribbert, to the protoplasmic 
condition of the cells of the glomeruli; by Kosenbach, to 
superfluous albumin in the blood, due to too rapid disinte- 
gration of blood-corpuscles; and, by Senator, to the increased 
vascular pressure in the glomeruli coincident with increased 
loss of water through the skin and lungs and disintegration 
of blood-corpuscles. In the urine of the healthy adolescent 
it is ascribed to rapid growth and development ; and in the 
urine of healthy adults, to excessive muscular activity, the 
ingestion and digestion of highly albuminous foods, mental 
excitement, and cold bathing. Does the state of pregnancy 
present any conditions analogous to these alleged causes of 
physiological albuminuria occurring in males and non-preg- 
nant persons ? If so, why should not a similar result follow ? 
It may be straining facts too far to insist that the increased 
arterial tension, the blood-degradation, the rapid growth and 
development, the mental disquietude, the augmented cutaneous 
and pulmonary exhalations, and anaemia of pregnancy are phe- 
nomena similar to' those present in otherwise healthy infants, 
adolescents, and adults, in whose urine albumin may be found; 
but the conclusion will not appear so overdrawn when to 
those conditions may be added the probable disturbance of the 
functions of the liver, the almost constant presence of alimen- 
tary and nervous perturbations, and possible ingestion of an 
excessive quantity of highly albuminous foods, which are 
occasional factors in the causation of albuminuria. Special 
mention is made of cold bathing as a cause of physiological 
albuminuria. May not sudden chilling of the cutaneous sur- 
face, rapid dissipation of heat, and consequent determination 
of chilled blood to the internal organs be an equally effective 
agency, when the result of imprudent exposures and insuffi- 
cient clothing ? Cold bathing, though a frequent, is not such a 

17 



258 ESSA YS AND ADDRESSES. 

common practice among pregnant women as other indiscreet 
exposures of the person to chilling influences. 

Pregnancy exhibits during its progress many other phenom- 
ena not unlike those frequently associated with albuminuria 
in non-pregnant persons, and believed to be active agencies in 
the causation of such pathological conditions. The most com- 
mon immediate cause of puerperal albuminuria, and perhaps 
an equally frequent cause in the non-pregnant, is the increased 
tension of blood in the glomeruli, either from increased affer- 
ent pressure or undue efferent resistance. The arterial tension 
of pregnancy finds its causes in the enlarged left ventricle, 
greater blood-mass, blood-degradation, disturbances of the ex- 
cretory organs, especially of the skin and bowels, and de- 
rangements of the nervous system, either local, general, or 
reflex. The efferent resistance may be either capillary or 
venous, and may be due to functional or mechanical condi- 
tions. If, then, these phenomena are physiological iu the 
pregnant female and pathological in the non-pregnant, and 
in each instance stand in like etiological relation to albumi- 
nuria, must the appearance of albumin in the urine differen- 
tiate an abnormal from a normal pregnancy ? Experience 
tells us that in many cases of pregnancy very large quantities 
of albumin appear in the urine without the occurrence of 
any serious complication, and that it usually disappears after 
delivery, and sometimes after the death of the foetus in utero. 
It may be physiological in a few, functional in many more ; 
but we must in the future, as in the past, continue to regard 
it as pathological in the majority of cases, and as a danger- 
signal of the gravest importance. 

With this ensemble of physiological conditions and patho- 
logical possibilities, do you marvel that some pregnant women 
get sick and a number die ? It is no answer to tell me that 
the ailments and mortality of pregnancy are incidents of edu- 
cation and civilization. If so, the most effective method of 
hygiene would be the relegation of every pregnant woman to 
besotted ignorance, barbarism, and beastliness — a remedy more 



ESSAYS AND ADDRESSES. 259 

revolting than " Vou-doo" medicine, which traces cause and 
effect and disease and recovery to stupid, disgusting, and 
criminal superstitions. In view of the facts that among civ- 
ilized people the average lifetime is greater, the mortality 
of the lying-in is less, and more women live out the allotted 
lifetime now than during any previous period of medical his- 
tory, I repudiate any analogy derived from the customs, 
habits, practices, and their results among nomadic, aboriginal, 
and barbaric races and peoples. With the progressive im- 
provements in the conduct and management of the pregnant 
and puerperal states the expectancy of life and longevity of 
the post-cessation life have increased. 

The hygiene of pregnancy demands an acuteness and accu- 
racy of diagnosis not always or easily acquired. The physio- 
logical so frequently approaches the pathological that differen- 
tiation of disease is involved in embarrassing obscurity. The 
insidious beginning of morbid processes is often so ill-defined 
and the consequences of delay are so disastrous that the ac- 
coucheur cannot afford to abide the issue of complete devel- 
opment when the diagnosis is plainly written in the picture 
of a grave disorder threatening immediate danger. He must 
be alert, accurate, ready, and self-reliant. 

The present occasion does not permit me to engage in a 
detailed description of the special disorders of pregnancy. I 
must assume that you are quite as competent as I am to recog- 
nize and treat such diseases. But, following the line of argu- 
ment previously pursued, I must insist that the most effective 
method of prevention of the complications of pregnancy con- 
sists in the preservation of the normal functional activities of 
the excretory and emunctory organs. 

The constant and necessary physiological relation subsisting 
between the skin, lungs, alimentary tract, and kidneys de- 
mands vigilant supervision. Constipation should be relieved. 
No fecal mass should be allowed to accumulate in the intes- 
tines. The bowels should be kept in a solvent condition and 
an evacuation should be secured very day, either by regulating 



260 ESSAYS AND ADDRESSES. 

the diet and habits of the patient or by such mild, but suffi- 
ciently effective therapeutic agents as a skilled discretion may 
suggest. 

It often happens that patients deceive themselves by inat- 
tention, and their medical attendant either by evasive or exag- 
gerated statements concerning the state of their bowels. As 
a rule, one can verify or not, as the case may be, such state- 
ments by an examination of the tongue and conjunctiva?, by 
malodor of the breath and person, and by inquiries in regard 
to the condition of the stomach, appetite, aud digestion, the 
nature and quantity of food, when and how often taken, and 
whether the ingestion of food and drinks is accompanied or 
associated with any sense of fulness, discomfort, flatulence, or 
acidity. Not only will a careful investigation detect the exist- 
ence of habitual constipation when a positive assurance to the 
contrary has been given, but it may disclose the cause, and 
indicate at once the method of treatment. 

The inspection of exposed cutaneous surfaces will be greatly 
aided by palpation. Cleanliness of the skin and the free 
functional activity of the sebaceous and sudoriparous glands 
must be secured by necessary tepid or hot ablutions or bath- 
ing. Cold bathing is not always safe. The drinking of 
large and unnecessary quantities of liquids — an injurious 
habit with very many people — imposes augmented labor upon 
those organs charged with the exhalation of fluid. Excessive 
micturition and profuse sweating are occasionally annoying 
results of the excessive consumption of liquids. 

The respiration may be embarrassed by the mechanical 
repletion of the abdominal cavity and by the altered contour 
of the thorax, which are unavoidable conditions. This discom- 
fort may be greatly aggravated by flatulent distention and 
overloading of the alimentary tract, due to the ingestion of 
acescent and unsuitable foods, and to constipation before 
referred to. A more significant disturbance of the respiration 
may result from the blood-degradation and anaemia. 

The constituent and dynamic changes in the circulation 



ESS A YS AND ADDRESSES. 261 

more often, perhaps, pass the physiological limit than any 
other of the phenomena of pregnancy. The blood is a fluid 
tissue. Into it are poured (Osier) the commodities needed 
for nutrition, and from it the other tissues derive the materials 
they require. Notwithstanding the ceaseless change and ex- 
change which go on, a uniformity of composition is one of the 
striking characteristics of health. The blood-plasma is sup- 
posed to supply nutriment to the tissues, and the red blood- 
corpuscles are the carriers of oxygen and carbonic acid. In 
pregnancy the former is greatly diluted, and the latter greatly 
diminished in number. When these changes pass the limit 
of health the consequences are numerous and may be serious. 
Cell-nutrition is interrupted ; formative activity is lessened ; 
the metabolism of tissues is disturbed ; waste increases, fol- 
lowed by impaired appetite, enfeebled digestion, loss of phys- 
ical vigor, increased nerve- irritability, altered and diminished 
excretion and secretion, with occasional cerebral and intellec- 
tual disturbances. These conditions may be associated with 
some one or more of a variety of resultant nervous perturba- 
tions, or other not uncommon disorder of pregnancy. The anae- 
mia of pregnancy is, to a greater or less degree, always present. 
As an element of causation in the production of the diseases 
of pregnancy it cannot be excluded, and must be accepted as 
the most constant and potential factor. To it, and to the 
mechanical disturbances of the abdominal viscera, and inter- 
ference with the function of respiration, we must look for the 
causes of most of the morbid complications of pregnancy. 
When this anaemia has reached a high grade its ravages are 
not easily arrested during the continuance of pregnancy. Our 
best and most successful efforts never free us from the appre- 
hension of recurring danger. Prevention is the sheet-anchor. 
To accomplish this effectively a vigilant supervision of the 
patient is imperative. The diet must be regulated and adapted 
to existing circumstances ; disturbances of the alimentary tract 
must be obviated ; the excretory and eliminative functions 
must be protected; sufficient sleep must be secured ; all sources 



262 ESSAYS AND ADDRESSES. 

and causes of anxiety, irritation, and excitement must be 
removed ; and last, though not the least important, exercise 
in the open air must be insisted upon. To these hygienic 
measures such therapeutic treatment should be added as intel- 
ligent experience and observation have proved to be useful. 

The hygiene of person should be supplemented with the 
hygiene of habitation and sleeping-apartments. A large, 
dry, well- ventilated and well-lighted room, above the ground- 
floor, should be selected for the sleeping-apartment, and this 
should be in a dwelling equally faultless in regard to ventila- 
tion, dryness, sunlight, and freedom from noxious effluvia 
and sewer or deleterious exhalations. As pregnancy advances 
the clothing should be adapted to the changes in contour and 
form ; all tightly fitting garments, stays, garters, and other 
uncomfortable appendages should be either entirely dispensed 
with or so adjusted as to remove unequal pressure and avoid 
the constriction of parts. 

In conclusion, a few words personal to myself. This meet- 
ing terminates the third year of the existence of this Society 
and closes the third term of my presidency. I have endeav- 
ored to discharge the duties of this office with impartiality. 
If mistakes have been committed, do me the favor to ascribe 
them to errors of judgment. I could not expect to enjoy this 
honor any longer, nor would it be just to other members 
equally if not more deserving and competent. Accept my 
thanks for the honors you have conferred upon and the con- 
fidence you have reposed in me, and believe that it will give 
me great pleasure to welcome your choice as my successor to 
these duties and this high honor. I wish each one and all 
of you health and long and prosperous lives. 



ESSAYS AND ADDRESSES. 263 



ADDRESS OF WELCOME 

DELIVERED TO THE CONGRESS OF AMERICAN" PHYSICIANS 
AND SURGEONS AT WASHINGTON, SEPTEMBER 18, 1888. 

Mr. President and Gentlemen : In behalf of the Com- 
mittee of Arrangements, and of the profession and citizens of 
this city, I bid you welcome. 

The circumstance of the simultaneous assemblage here to- 
day of the special medical societies of this country will mark 
an epoch in the history of the American medical profession 
which must redound to its honor and renown. In the fact 
that it brings together at the same time and place those bodies 
of men which hold in their membership so many who have 
devoted their lives and energies to the study and development 
of special branches of medical science, and have won by their 
work pre-eminence as skilled physicians and surgeons, in an 
organization that offers the unusual opportunity, by systematic 
arrangement, for the consideration, by specialists equally dis- 
tinguished in different branches, of subjects as yet unsettled 
but of general medical interest, it is, perhaps, the most remark- 
able concourse of medical men that has ever assembled in this 
country. While it sets forth conspicuously this distinctive 
feature, it in no manner interferes with the autonomy of the 
constituent societies, each of which pursues its chosen method 
according to its own plan of organization. 

It utters no word in derogation of organized effort through 
allied associations ; nor does it directly or by implication seek 
to control, direct, or influence the business aspects of the pro- 
fession ; but devotes thought and act solely and exclusively 
to the advancement of the science of medicine. With such a 
purpose in view no apology is needed for your presence here. 

The gratification it gives me to welcome you is enhanced by 
the presence of the distinguished men from other countries, 



264 ESSAYS AND ADDRESSES. 

who have come to honor and encourage us, and to make 
" assurance doubly sure " that the promise to contribute some- 
thing to the common fund of knowledge will be fulfilled. 

I welcome you also as a citizen of the city located by Wash- 
ington and planned by L'Enfant, under his supervision, which 
has grown during the first century of its existence into a city 
surpassing in beauty and rivalling in attractiveness the more 
favored and older cities of both the old and new worlds. A city 
representing in its population sixty millions of free people 
inhabiting a domain stretching across a continent from ocean to 
ocean and from the frigid north, where the summer solstice 
finds the earth buried in snow and ice, to the evergreen and 
tropical south. A city holding together in one compact com- 
munity a cosmopolitan population where education and culture 
need neither the blazonry of titular insignia, the heraldry of 
ancestral distinction, nor the glamour of wealth to command 
position and influence. Where the lady and gentleman can 
always find congenial and cultivated companionship free from 
the conventional and exclusive formalities which disrupt 
society into graded coteries of self-constituted notables. A 
city which you will not be surprised to find has attracted the 
cultivated and leisure classes from every State and city in 
the Union. 

I welcome you also as a citizen of the National Capital, 
richly endowed by a munificent government with foundations, 
not as yet complete in any department, but steadily progress- 
ing toward that standard of excellence and usefulness which 
will, in the near future, make the political home of the nation 
the centre of science, literature, and art. 

I need hardly tell you, gentlemen, how much this govern- 
ment has done for our profession. You know of the Medical 
Library, unequalled in volumes and value, and the Medical 
Museum, with its anatomical and biological laboratories, 
unsurpassed by any similar collection in the world, both now 
located in a building constructed for the purpose, and so 
arranged as to exhibit their extent to casual inspection, and 



ESSAYS AND ADDRESSES. 265 

to enhance their value for appropriate and available purposes. 
In connection with this magnificent library the publication of 
the Index- Catalogue j which enables the investigator to study 
any medical subject from its beginning down to the latest 
publication, and of which it is not too much to say that it 
will contribute more toward the higher education of the pro- 
fession than any single act of any nation on the face of the 
globe. And all this has been accomplished in the lifetime of 
one man, who still lives to prosecute his labors with that dili- 
gence, fidelity, and pertinacity which mark the unselfish and 
conscientious enthusiast. 

Then, too, the government has established, in connection 
with the Bureau of Naval Medicine and Surgery, a Museum 
of Hygiene, which offers to every citizen the opportunity to 
examine and study the relative advantages and utility of every 
device and appliance for the improvement and perfection of 
the hygiene of the dwelling. Under the fostering care of a 
liberal government and the conscientious discipline of the 
Naval Bureau of Medicine this establishment has already 
become an important adjunct to preventive medicine, and will, 
without doubt, continue to grow in usefulness both to the 
government and to the country at large. 

The National Quarantine and Marine-Hospital Service is 
another establishment which allies the government with the 
medical profession and brings it close to the people of the 
country in its beneficent purpose to provide for the sick and 
disabled sailors of the merchant and revenue marine, and to 
prevent the introduction and spread of contagious diseases into 
the country through its maritime ports. 

It may be that the government required these establishments 
to fulfil its delegated functions, and is compelled to secure 
the services of skilled medical men to superintend their proper 
administration ; nevertheless, even admitting this necessity to 
be the primary cause for their creation, it in no manner im- 
pairs their value to the profession, and their foundation im- 
poses upon us the duty to utilize them for the common good, 



266 ESSAYS AND ADDRESSES. 

and invites us to aid to develop and widen the scope of these 
endowments to the end that we and the people may realize 
the full measure of their usefulness. 

The Bureaus of Army and Navy Surgery are also located 
here. It is true they are corps, constituting important and 
essential parts of the complete equipment of the military estab- 
lishment of the nation. They are, nevertheless, the instru- 
mentalities through which the government has been enabled 
to call into its service medical men of the highest order of 
professional attainments, and to accomplish so much in pro- 
moting the advancement of scientific medicine. 

The government has been equally generous toward other 
departments of science. If the time and occasion permitted, 
it would give me great pleasure to lay before you, in detail, 
the work being done in the scientific bureaus established and 
supported by the general government in this city; and, also, to 
refer to the eleemosynary and educational institutions founded 
and exclusively supported by the government, as well as others 
to which it contributes annually a liberal though partial sup- 
port. I must, however, be content with the bare statement 
of the fact that you may carry home with you the conviction 
which I wish to impress upon you, in behalf of our city, that 
by virtue of the foundations and endowments of the govern- 
ment it has become a scientific and educational centre equal 
to any and surpassing most of the older, richer, and more 
populous cities of the country. In this connection I cannot 
omit reference to her admirable system of common schools and 
her universities : that of Georgetown, with its departments of 
humanities, philosophy, and science, and of law and medicine; 
the Columbian, with its preparatory, scientific, law, and med- 
ical departments ; the National, limited, as yet, to law, medi- 
cine, and dentistry ; the Howard, especially devoted to the 
education of colored citizens, with departments of literature, 
law, medicine, dentistry, and theology ; and, finally, the new 
Catholic, now in course of organization and construction. 

To all this let me add the Smithsonian Institution with its 



ESSAYS AND ADDRESSES. 267 

annexes of the National Museum and the Fish Commission ; 
the Department of Education ; the National Academy of Sci- 
ences, which, by law, is required to hold its annual sessions 
in this city ; and the voluntary scientific organizations known 
as the Philosophical, Biological, and Anthropological Socie- 
ties, which bring together at stated periods the men of learning 
and science residing here either officially or for convenience 
or comfort, and you will realize something of the scope and 
importance of the scientific and educational work now carried 
on in this city, as well as the prominent position already 
achieved by science and the justification for our faith in the 
greatness of its future. 

And now, having briefly suggested our present and prospec- 
tive claims to a prominent place as a scientific centre, will you 
not join with me in the hope that this, the cosmopolitan city 
of the nation, the heart of its political life, may also speedily 
become its scientific and educational Mecca as well ? 

There is still another relation which the government holds 
to its capital, the wisdom of which one cannot fully appreciate 
without a residence long enough to observe its practical bear- 
ing. By a provisiou of the Constitution the territorial area 
is held under the exclusive jurisdiction of Congress. The 
government holds in fee simple the title to all the public high- 
ways, the public buildings, and the numerous parks ; makes 
all laws ; appoints all officers ; levies, collects, and disburses all 
taxes ; and contributes an equal amount to the support of the 
municipality. To her the citizens are indebted for these beau- 
tiful streets, the avenues of shade-trees, the flowing fountains, 
and the decorated parks which adorn the landscape at every 
turn with foliage, flowers, and sward, and contribute so much 
to the healthf ulness of the city. 

This is the capital of a great, growing, and prosperous 
nation, beautiful in design and susceptible of greater and 
more magnificent embellishment. Every citizen of the country 
should share in the wish for its substantial improvement 
and adornment, that it may become commensurate with its 



268 ESSAYS AND ADDRESSES. 

importance and capabilities. The time is not very remote 
when the fostering care of a generous government and the 
energy of its resident population will make it the most desira- 
ble city for residence in this great and populous country; 
when its suburban elevations will be covered with winter 
residences and summer villas rivalling in beauty and grandeur 
the taste and display along the cliff at Newport. 

I need hardly tell you that Washington is a healthy city; 
but I will send a message through each one of you to the 
people at your homes, that you may tell them how much their 
government is doing to improve the healthf ulness of this city. 
In times past we have read the graphic descriptions of the 
dreadful malaria that was so dense it could be sliced into 
blocks, followed people in fierce pursuit at every turn during 
the day, howled under the eaves at night, stole through the 
stomach, and sneaked under the nether garments. But, thanks 
to the government, the river-marshes are being reclaimed, and, 
in the near future, the river-front of our city will be covered 
by a magnificent park, washed along its entire shore by the 
swift current of a river of drinking-water. %, You may tell 
them too, if you please, that the malaria of the correspondent 
and casual visitor covers some one or more of the great variety 
of excesses which prudent people should not commit. Take 
home with you this message, from one who has lived forty 
years in sight of and breathed the air coming with every 
southern wind over the Potomac flats, and has never yet had 
the fever and ague. 



ESS A YS AND ADDRESSES. 269 



AMERICAN GYNECOLOGICAL SOCIETY. 



ADDRESS OF WELCOME TO THE AMERICAN GYNECOLOGICAL 

SOCIETY, DELIVERED AT WASHINGTON, 

SEPTEMBER 18, 1888. 

Mr. President and Fellows : The American Gyneco- 
logical Society is always welcome in this the nation's capital 
city. We are, it is true, indebted to the courtesy of the 
Boston Fellows, who voluntarily relinquished their claim, 
even after their city had been selected as the place for the 
present meeting. Yet the Resident Fellows, the profession, 
and citizens of this city, and the members of other special 
medical societies which have assembled here to-day, offer to 
you the welcome which is due to an organization of physi- 
cians which numbers among its membership so many men 
whose scientific work is known throughout those parts of the 
civilized world where medical science is cultivated and appre- 
ciated. 

As the Chairman of the Committee of Arrangements of 
the Congress of American Physicians and Surgeons, I take 
more than ordinary pleasure in bidding you welcome to-day. 
You have come to meet others equally eminent in the various 
special departments of medicine, who are seeking to perfect 
and solidify an organization which will unite men of pre- 
eminent abilities in a common effort to elevate medical science 
in this country to that high standard which shall be commen- 
surate with the progress of research into the cause, nature, 
and treatment of disease. You have come also to meet and 
have brought with you men from abroad whose honorable 
bearing and good work have added lustre and renown to the 



270 ESSAYS AND ADDRESSES. 

profession. Since you Lave come to aid others in their efforts 
to promote the welfare of a common humanity, I need not, 
therefore, offer any apology for the gratification it gives me 
to welcome you to-day. 

Without your presence the assemblage of distinguished men 
here to-day would have seemed incomplete. A society that 
has given to the world thirteen volumes of transactions re- 
plete with valuable information, and has won in this country 
certainly the leadership in obstetrics and gynecology, could 
not relinquish its position as the equal of any other special 
medical society by its absence from this city on this occasion. 
It must necessarily be a constituent part of any great assem- 
blage of eminent physicians and surgeons. And the welcome 
I give you is enhanced by the fact that your presence assures 
the success of an organization which will establish a new era 
in the history of American medicine ; an era that means a 
pull altogether, and all along the line, to promote the progress 
of scientific medicine. While I cannot offer you the excel- 
lence in social entertainment with which the Boston Fellows 
would have greeted you, I will promise you a more varied 
intellectual feast. 



THE WRONG OF CRANIOTOMY UPON THE 
LIVING FGETUS. 

SIXTH ANNUAL ADDRESS OF THE PRESIDENT, DELIVERED 
BEFORE THE WASHINGTON OBSTETRICAL AND GYNE- 
COLOGICAL SOCIETY, OCTOBER 19, 1888. 

In my first annual address, delivered before this Society 
five years ago, I predicted that the discussion of the relative 
propriety of the operation of craniotomy upon the living 
foetus and the Csesarean section, then in progress, would 



ESSAYS AND ADDRESSES. 271 

result in a modification of the views held by a majority of 
obstetricians, and that the time would come when the Cesa- 
rean section and other conservative procedures which offered 
the chance of saving two lives would supplant the killing of 
the foetus that the chances of the mother's recovery might be 
improved. I did not then anticipate the rapid progress of 
the revolution which I felt assured had begun, nor that, at 
this early date, science would have so nearly accomplished 
that result. After five years' submission, without remon- 
strance, to adverse criticism, you will pardon my expres- 
sion of the pleasure it gives me to recur to this subject, 
not, as then, a postulant, canvassing the issue of justifiability, 
but now, as a predicant, asserting the wrong of craniotomy 
upon the living fcetus. This proposition advances a step be- 
yond the inquiry discussed in my first address, and involves 
the question of moral responsibility as well as the issue of 
scientific investigation and result. It may be that my views 
are extreme ; but if advances in the science and practice of 
obstetrics are limited to the domain of long-established usage 
and generally accepted principles, progress must cease. If the 
early followers of McDowell had laid aside the scalpel at the 
bidding of their assailants, abdominal surgery would not now 
be crowned with the brilliant successes of the great ovarioto- 
mists whose achievements are known in every land where 
medical and surgical science is cultivated. Nay, more ; if they 
had been discouraged by the unfavorable results in the begin- 
ning, ovariotomy would long since have been consigned to 
the catalogue of unjustifiable operations, and the unnecessary 
sacrifice of woman's life would have continued as a memorial 
of the inadequacy of scientific medicine. 

To state the issue plainly, the averment must be made that 
no conscientious physician would, deliberately and wilfully 
kill a foetus if he believed that the act was a violation of the 
commandment, " Thou shalt not kill." It has been well 
said by Barnes, 1 the highest authority on operative obstetrics 

i British Medical Journal, October 2, 1886, p. 624. 



272 ESSAYS AND ADDRESSES. 

and the ablest and most conservative defender of craniotomy, 
" It is not simply a question for medicine to decide. Keligion 
and the civil law claim a voice — a preponderating voice. In 
the whole range of the practice of medicine there arises no 
situation of equal responsibility, of equal solemnity. " Main- 
taining 1 the affirmative of the proposition that the profession 
can and must escape from such a solemn responsibility, I 
hold that we must strike directly at the root of the evil, 
which declares that " it is the mother's right to save her life 
even at the sacrifice of her child/' and abolish a plan of 
treatment which the experience of past ages has handed 
down to us and vindicated by the assertion of the right to 
take one life rather than leave two to die. We must, in the 
interest of a broader humanity and a far wider field of use- 
fulness, accept the progress of science and offer chances to 
two lives, rather than take the one which cannot assure the 
safety of the other. In the remote past, when obstetric opera- 
tions were at best performed with rude appliances and in a 
bungling and unscientific manner by operators lacking in 
knowledge and experience, such interpretation of the moral 
law must have been cherished as a blessing to humanity ; but 
" under the new regime the interest of the living child 2 will 
constitute a more important factor," and the public will 
demand the highest skill attainable in obstetrics. Directly 
opposed to such progress is the assertion of the right to take 
life at will, supported by the equally untenable assertions of 
easy accomplishment 3 and small mortality of mothers. With 
the issue thus made up, I proceed. 



1 The improved operation has given results in Germany so satisfactory that possibly' 
the day is at hand when craniotomy upon the living foetus will be very rarely per- 
formed, if done at all.— Parvin, Medical News, vol. lii. p. 652. 

2 Prof. Miller : Transactions Ninth International Congress, vol. ii. p. 304. 

3 " To reduce the bulk of the child, or to extract its mutilated remains through a 
pelvis of two and one-half or less conjugate, is an operation of extreme difficulty, one 
occupying a very considerable period of time, and needing for its successful accom- 
plishment, as far as the mother is concerned, a very great experience and an amount 
of manual dexterity hardly to be acquired outside of a large city ; while, on the other 
hand, the Caesarean section is an easy operation, capable of successful performance 



ESSA rS AND ADDRESSES. 273 

The right or wrong of craniotomy upon the living foetus 
forces itself into the foreground of this discussion because this 
unsettled issue is the obstacle thwarting the advance in the 
methods of conservation of human life. Until the unjustifi- 
ability of the alleged right to kill a foetus at will to enhance 
the chances of life to the mother is fully demonstrated, and 
the wrong of it laid bare in the fulness of its enormity, the 
law of justification will be invoked to cover the plea of 
expediency. 

I will not characterize craniotomy upon the living foetus 
as a crime in the ordinary acceptation of the word — that is, a 
deliberate, wilful, and malicious malefaction. Nor would I 
invoke the enactment of penal laws upon the subject. 1 Nor 
do I assume censorship of professional conscience. Neither 
do I maintain that one who may differ with me is necessarily 
wrong. I concede to every qualified obstetrician the right of 
private judgment, and recognize the moral responsibility of 
every one for his own acts. Nevertheless, I would seek to 
cultivate and disseminate a higher and broader conception of 
moral duty than that which reposes in conscientious security 
upon the assumed right to kill an unborn child " in the in- 
terest of the life of another, responsible for its existence," 
when there is sufficient evidence to justify other procedures 
" equally in the interest of both mother and child." 2 

by any surgeon of ordinary skill." — Kinkead, British Medical Journal, October 2, 
1886, p. 626. 

" Tbe argument tbat sucb operations as tbat of Porro would fall largely, of neces- 
sity, into tbe bands of men inexperienced in abdominal surgery was not of mucb 
value; for exactly tbe same tbing was true of bad cases of craniotomy, and be 
felt certain, of tbe two classes, under similar circumstances, tbe resulting advantages 
would be largely on tbe side of amputation of tbe uterus."— T ait, British Medical 
Journal, October 2, 1886, p. 627. 

1 " I would welcome the enactment of laws against tbis practice in all civilized 
countries."— Wathen, Transactions Ninth International Medical Congress, vol. ii. 
p. 372. 

2 Mr. Tait feels certain that ''the decision of the profession will be before long to 
give up the performance of those operations destructive to the child in favor of an 
operation which saves it, and subjects the mother to little more risk." — British Medi- 
cal Journal, October 2, 1886, p. 624. 

The operation of amputation of the pregnant uterus, I venture to predict, will 
revolutionize the obstetric art, and in two years we shall hear no more of craniotomy 

18 



274 ESSAYS AND ADDRESSES. 

While I forbear to characterize the sacrificial operation as 
a crime, I will antagonize the charge of sentimentality so fre- 
quently and flippantly made against those who would offer 
chances to two lives rather than take the one which cannot 
assure the safety of the other, with the counter-charge that 
those who claim the right to take life as the mere choice of 
obstetric or surgical procedure assert a prerogative as arbi- 
trary in its conception as it is cruel in its execution. An 
operation which, in a spirit of evasive defence, has been 
admitted by its advocates and defenders to be abominable, 
repulsive, horrible, detestable, and execrable, must partake 
more of the nature of a sacrilege than a sacrifice ; and that 
sentimentality which, by its abolition, would relieve obstetric 
science from the necessity of such dreadful admissions, needs 
no other defence than the courage to assert itself. 

The killing of the unborn foetus must be intentional and 
deliberate and executed intelligently, or otherwise it is mani- 
festly a crime. In the present state of medical and obstet- 
rical science ignorance, haste, convenience, and want of prep- 
aration cannot be offered as pleas in abatement of the wrong. 
Incompetency to do that which others can do cannot justify 
a foeticide. Intentional and deliberate killing must find its 
justification in some law, either civil, scientific, or moral. 
Self-preservation is the first law of nature ; but neither the 
civil nor the moral law will accept the arbitrament of any 
one man's judgment on so momentous a question. Criminal 
law assumes to ascertain and measure the degree of guilt by 
defined methods of judicial procedure. Established usage may 
constitute an adequate plea in justification or abatement of 
many wrongs committed in the ordinary concerns of human 
life, but it offers no escape from the responsibilities of crim- 
inal acts, even though it may mitigate the punishment of 



or eviscerations, for this new method will save more lives than these proceedings do, 
and it is far easier of performance. It is the easiest operation in abdominal surgery, 
and every country practitioner ought to be able and always prepared to do it.— 
LawsonTait, Medical Record, November 10, 18S8, p. 557. 



ESSAYS AND ADDRESSES. 275 

penal offences. Custom and usage may excuse, and civil 
and criminal law may acquit the accused ; but neither of these 
avenues affords escape from the moral responsibility of inten- 
tional and deliberate killing. 

I do not introduce the references to the civil and criminal 
law to degrade the alleged wrong of craniotomy upon the 
living foetus to the level of an ignominious offence, but to 
exclude the argument of justification based upon the absence 
of common law or statutory prohibition, and to reassert the 
principle of moral responsibility above and beyond any legis- 
lative definition. 

It is established by the consensus of professional opinion 
that the operation has been frequently performed in cases 
where delivery could have been safely accomplished by the 
forceps, turning, or even by the unaided powers of nature. 
A dogma that accepts and justifies a procedure conducive to 
results so repulsive to Christian civilization and humanity, 
and so obstructive to the progress of science, should seek 
defence upon a higher plane of professional duty than the 
mere assertion, without proof, of the right to take the life 
of one innocent human being to increase the chances of the 
recovery of another. 

The wrong of craniotomy on the living foetus is a more 
complex offence than a wrong act inflicted upon one's self. 
If the moral dereliction could be limited to the responsibility 
of the operator, it might be submitted to the arbitrament of 
his own conscience; but the greater offence is committed 
against the purest type of an innocent and defenceless human 
being — an unborn child which has reached that stage of its 
development which fits it for an independent life — at the will 
and on the judgment of one whose office and duty it is to pre- 
serve that life. 

Conception is the product of cohabitation. With cohabita- 
tion and insemination the function and office of the male in 
the production of a new being terminate. Not so, however, 
with the female. The laws of procreation entail upon the 



276 ESSAYS AND ADDRESSES. 

woman the obligations and responsibilities of maternity, which 
are equally as high in the scale of natural attributes and more 
imperative in all the requirements for their complete fulfil- 
ment. It must then follow that the child is entitled to life, 
even at increased risk to 1 the mother. The doctrine of re- 
sponsibility of the operator for his own act cannot condone 
the composite offence. He may but play the part of accom- 
plice in the final act of the drama of the wrong, but the 
bloody hand may be none the less guilty, for complicity and 
connivance are, at least, accessory wrongs. Women in 
travail are not infrequently terrorized at the mere sugges- 
tion of the necessity of manual or instrumental interference, 
but accept with alacrity any alternative which promises to 
terminate their agony. It quite as often happens that the 
grief of a disappointed and blighted maternity can only be 
solaced by the coming of another. If the improved Cesarean 
section is not necessarily fatal to either mother or child, and 
offers fair promise of life to both, and craniotomy falls far 
short of such a promise, while it loads the mother's heart 
with sorrow and taints her life with guilt, surely the accom- 
plice of such a deed of evil cannot ransom the wrong with 
the dogma of absolution by virtue of his doctorate in medi- 
cine. 

The mother's love of offspring is the most acute and in- 
tense passion of human life and animal instinct. No obste- 
trician need be reminded of the anxious inquiries concerning 
the safety of her child so often made during the agony of her 
travail, her joy at the first cry of independent life, her devo- 
tion to the infant at the breast, and her willing sacrifice of 
strength, health, comfort, and pleasure during the after-life 
of the fruit of her womb. Are such qualities mere exhibi- 
tions of emotion induced by the current, passing, and evanes- 
cent events of her life, or are they attributes of that divinity 
of soul that makes her the helpmeet of man and the emblem 

1 Thomas. 



ESSAYS AND ADDBESSES. 277 

of all that is pure and good in life ? The attributes of mater- 
nity find their beginning in the innate qualities of human life ; 
manifest their obvious presence in the amusements, pleas- 
ures, and pastimes of infancy and childhood ; grow with 
pubertic development ; intensify with adolescence ; and attain 
fruition with the birth and care of a living child. From its 
beginning to the end of intellectual life maternity is a cease- 
less passion, enshrined in truth, virtue, sincerity, forgiveness, 
and self-abnegation, and hallowed " in devotion of the heart 
in all its depths and grandeur." The sublimity of such 
natural endowments carries with it the force and conviction 
of condemnation of wilful assent to and complicity in the 
destruction of a foetus at maturity, and asserts the preroga- 
tive of a child to live at increased risk to the mother. It 
cannot be that the complex processes of conception and utero- 
gestation, the organization, construction, and equipment of a 
new being for an independent life, and the agony and danger 
of parturition mean nothing more than the right of life by 
consent of mother and the will of the accoucheur. 

There can be no higher obligation of professional duty than 
the promotion of the welfare and the saving of the lives of 
those committed to the care and judgment of a Christian 
physician. This duty cannot be wholly discharged short of 
the conscientious and intelligent application of such resources 
of art and science as may be known to promise the best result. 
When two beings are in equal danger, the killing of one not 
necessary to and not assuring the safety of the one respon- 
sible for the existence of the other and the danger of both, 
cannot fill the measure of such duty when a less violent pro- 
cedure offers a reasonable prospect of saving both lives. In 
rebuttal, the logic of fallacy alleges that the killing of the 
first child may preserve a life which may so multiply that 
the aggregate saving of infant and maternal life will surpass 
anything that is likely to be obtained by the Csesarean sec- 
tion. This sophism takes no account of the uncertainties of 
events, encounters the danger to both mother and child of 



278 ESSAYS AND ADDRESSES. 

premature labor induced at varying periods of foetal viability, 
and suppresses the rule of successive breeding and killing at 
the pleasure of the woman and the will of the operator. It 
wholly ignores the fact that the Csesarean section may, with 
slightly less percentage of chance to the mother, save both 
lives and restore to the woman incapacitated by pelvic de- 
formity the privilege and power to give birth to an indefinite 
number of children, 1 and that Porro's modification may save 
both lives and prevent subsequent pregnancies. But such 
illogical reasoning finds its complete refutation in the absence 
of any clinical data upon which its allegation could be based, 
and the numerous instances in which women have preferred 
Csesarean section rather than permit a repetition of crani- 
otomy. There is no case known to me where a woman upon 
whom the section has been successfully performed has refused 
to submit to its repetition in a subsequent pregnancy. 

The sentence of condemnation has long since been pro- 
nounced against criminal abortion. No one of you would 
produce an abortion to conceal an illegitimate pregnancy, nor 
for any reason, except such as would, in your conscientious 
judgment, make the death of the mother, and consequently 
of the foetus, otherwise inevitable. Neither would you in- 
duce premature labor at any stage of foetal viability except 
to save the mother and to offer a reasonable — in many cases 
an increased — chance of life to the child. The death of a 
pregnant woman necessarily causes the death of an undeliv- 
ered child. According to the latest review of the subject, 2 
maternal mortality is 8.2 per cent., two-tenths less than that 
of craniotomy. 3 While the maternal mortality is but a frac- 
tion in favor of induced premature labor, the saving of life 
in the aggregate has so magnified the importance and advan- 
tages of the procedure that it has become an accepted and 

1 See the collection of cases of multiple Csesarean section by Lungren, American 
Journal of Obstetrics, vol. xiv. p. 78. 

2 Wyder : Ann. de Gyn. et d'Obstet., January, 1888 ; quoted from New York Medi- 
cal Journal, vol. xlvii. p. 641 . 

3 Ibid. 



ESS A YS AND ADDRESSES. 279 

established alternative of craniotomy, especially applicable in 
conditions of pelvic contractions in which the craniotomists 
insist the latter is the elective operation. The mortality of 
weak and immature children is very large, but the invention 
and application of the incubator of Tarnier have reduced it to 
36.6 per cent. ; so that the ratio of lives saved is as 155.2 
in 200 to 91.6 in 200 by craniotomy. It is then evident 
that the induction of premature labor has acquired priority 
in the chronological order of alternative procedures because 
of the aggregate saving of life ; and its universal acceptance 
gives emphatic expression to the supreme and dominating 
passion of maternity and to the widespread abhorrence for 
the dogma and practice of craniotomists. From this there is 
no escape, for there is no one capable of conscientious reflec- 
tion who would offer the condonement of two- tenths of one per 
cent, less of maternal mortality in favor of induced prema- 
ture labor for the deliberate killing of one hundred unborn 
children. But fairness even to such a reprehensible practice 
demands the statement that the artificial provocation of labor 
at a selected time is only applicable to such cases in u which 
previous clinical knowledge,, confirmed by exploration made 
before and during early gestation, has demonstrated the inca- 
pacity of the woman to bear a living child at term." Never- 
theless, the obligation to possess such knowledge at the ear- 
liest practicable period of pregnancy is not less imperative 
than it is to conduct her safely through the perils of her 
travail. 

" The brutal epoch of craniotomy " has certainly passed. 
" The legitimate aspiration and tendency of science (Barnes 1 ) 
are to eliminate craniotomy on the living and viable child from 
obstetric practice ; " and it may be that the realization of the 
dream of Tyler Smith 2 will be the crowning achievement of 
the surgery of the nineteenth century. 

Craniotomy is the oldest capital and most deadly obstetric 

i British Medical Journal, October 2, 1866, p. 623. 
2 Obstetric Transactions, London, vol. i. p. 21. 



280 ESSAYS AND ADDRESSES. 

operation. It was devised in the infancy of the art to rescue 
women from the difficulties then regarded as otherwise in- 
superable. The history of obstetric progress since that remote 
period points with significance to the fact that every great dis- 
covery (Tyler Smith) in this branch of medicine is in direct 
" opposition to it and has invariably tended to diminish the 
frequency of its performance where the child was living.' * 
Even the Cesarean and Sigaultian sections, which in the 
beginning were but little less fatal to the mother than per- 
foration is to the child, were attempts to escape the " mas- 
sacre of the innocents." Then followed in chronological 
order the discovery of turning, the forceps, and the induction 
of premature labor; and, subsequently, the application of 
oxytocics and auscultation to obstetrics ; the discovery of the 
physiology and mechanism of labor ; numerous minor im- 
provements ; anaesthesia, antisepsis, laparo-elytrotomy by 
Thomas, axis-traction forceps, Porro's operation ; and, 
finally,' the improved Cesarean section by Saenger. As 
century after century has slowly rolled into the oblivion of 
the past, so has the opprobrium of obstetrics receded before 
the gradual evolution of mere handicraft into a science which 
has saved empires of lives ; which now commands the ad- 
miration of the civilized world and daily receives the bless- 
ings of millions of women. The present has surpassed any 
previous century in scientific discovery and advancement. 
In no department of science has this advance been more 
marked than in medicine ; in no branch of medicine more 
than in obstetrics, and in none of the subdivisions of obstet- 
rics more than in the saving of maternal and infantile life. 
Nevertheless, this barbarous relic of a pre-anatomic period, 
with its aunual sacrifice of six thousand eight hundred and 
eighty lives in this country alone, 1 remains a blot on the 
marvellous progress of the nineteenth century and a reproach 

1 This result if obtained by a calculation made upon the basis of sixty millions of 
people, with a ratio of thirty-six births (U. S. census, 1880) to every one thousand of 
population, and the proportion of one craniotomy (Tyler Smith) in every three hun- 
dred and forty labors, the maternal mortality after craniotomy being 8.4 per cent. 



ESSAYS AND ADDRESSES. 281 

to our profession, so progressive in all other directions. The 
frequency of the operation is so dependent upon variability 
of judgment that this estimate may be more or less, according 
to the number, will, and judgment of the operators — the sen- 
tence and its execution being alike asserted prerogatives. 
Collins performed the operation once in 141 cases of labor, 
Clark once in 248, and Ramsbotham once in 805 ; whereas 
Siebold performed it only once in 2095, Baudelocque only 
once in 2898 cases, and More Madden, in a long and large 
experience in hospital and private practice, has never once 
recognized its necessity or countenanced its performance. 1 
The extraordinary frequency of the operation in the practice 
of competent obstetricians is explicable only upon the theory 
of an automatic belief in its justifiability, which invokes the 
more " sweeping doctrine of necessary blamelessness 2 for erro- 
neous conclusions," or the favorite and broader doctrine of 
Ingersoll, u the immunity of all error in belief from moral 
responsibility. " 

The discovery of McDowell encountered bitter prejudice 
and reproach, based upon the alleged unjustifiable sacrifice of 
the lives of women who were afflicted with a disease other- 
wise incurable. 3 It is true that some lives are shortened bv 
a period varying from a day or a week to a year or two ; but 
even in the beginning such mortality was less than 50 per 
cent, and since 1809 ovariotomy has rescued from protracted 
suffering and premature death fully 75 per cent, of the cases, 
and has added thousands of years to the lives of women. In 
each of such cases but one life was at stake. The Cesarean 
section, or some of its modifications, is performed in the in- 
terest of two lives, upon women who cannot give birth to 
their offspring per vias naturales. The opposition in this 
case is not less clamorous and unreasonable than in the other, 
notwithstanding the first fifty Saenger operations in Europe 

1 British Medical Journal, October 2, 1887, p. 627. - Gladstone. 

3 It is probable that occasional instances of cure resulted from the haphazard 
methods which have been long since abandoned. 



282 ESSAYS AND ADDRESSES. 

saved 80 per cent, of mothers and 96 per cent, of children, 
or 88 per cent, of all the lives imperilled, while the best pos- 
sible result in craniotomy — never, however, attained — would 
give but 50 per cent. This contrast exhibits the complex 
and contradictory methods which good and competent men, 
who have become set in their views, will employ to thwart 
and obstruct the advance of scieuce. In the former in- 
stance it was the possible shortening of the life of a woman 
fatally sick that aroused the fierce vituperation and denun- 
ciation; now it is the saving of 96 per cent, of children at a 
slightly increased risk to the life of the mothers that fires the 
heart of the philanthropist who claims the natural right to 
destroy one-half of the lives that the chances of saving the 
lives of the other half may be improved. The iron-clad con- 
science which sought to drive the early followers of McDowell 
into ignominious retirement lives only in the history of its 
futile efforts to obstruct progress, and ovariotomy has risen 
to the dignity of universal acceptation. The conscience 
which is to-day seeking to condone the wrong of craniotomy 
with the good that evil may bring will read a like history 
in the near future when the world will know the possibilities 
of science, and the child will be saved without enhancing 
the danger of the mother. As Tait 1 has accomplished the 
brilliant success of one hundred and thirty-nine consecutive 
ovariotomies without a death, we need not hesitate to give 
full credit to his opinion that one hundred Porro operations 
should not yield more than 5 per cent, maternal mortality. 2 

To meet the charge of casuistry the logic of words must 
be reinforced by the demonstration of facts. It is admitted 
that alternative procedures give better results to the mother, 
with high probability of saving the child, than craniotomy 
when: 



i British Medical Journal, May 15, 1886, p. 921. 

2 "If I had one hundred Porro operations to do, before craniotomy or any other 
turbulent proceedings upon the child had been attempted, I would not have a mor- 
tality of more than four or five per cent." — British Medical Journal, October 2, 1886, 
p. 624. 



ESSAYS AXD ADDRESSES. 283 

1. The conjugate diameter of the pelvis is two and one- 
half inches or less. 

2. When the shortest diameter measures three and one- 
fourth inches. 

3. In all cases of pelvic contraction when the opportunity 
of inducing premature labor has not gone by. 

4. In cases of cancerous degeneration of the lower uterine 
segment and vagina. 

5. In cases of immovable tumors, rupture of the uterus, 
convulsions, hemorrhage, and atresia of the cervix or 
vagina. 

6. In cases in which the pelvic cavity is obstructed by the 
presence of fibroid or other tumors. 

7. In other emergencies than deformity, as in obstructed 
labor from ovarian tumors. 

These limitations are based upon the following facts: 

1. That craniotomy cannot in any case assure the life of 
the mother. 

2. That it is necessarily fatal in every case to the child. 

3. That in many cases one operation demands repetition on 
the same woman. 

4. The maternal mortality varies from 7.1 to 12.5 per 
cent. 1 

5. The Cesarean section and other alternatives of crani- 
otomy are not necessarily fatal to either mother or child. 2 

To set forth more completely the limitation and inapplica- 



1 Munde (Annual of Universal Medical Science, vol. i. p. 218) says that, when per- 
formed hy experts under the most favorable conditions, it should not exceed 7.1 per 
cent. Merkel (Arch. f. Gynak., vol. xxi. p. 437) reports from the Leipsic clinic 100 cases, 
with 8 per cent, mortality. Thorn (Arch. f. Gynak., vol. xxiv. p. 437) reports 80 cases 
from the Halle clinic, with 12.5 per cent. Wyder (Ann. de Gyn. et d'Obst., Jan. 18S8) 
fixes it at 8.4 per cent. Of the ISO cases of Merkel and Thorn, 88 had previously given 
birth to living children. 

2 Csesarean section always held out promise when performed under favorable cir- 
cumstances.— Lvsk : British Medical Journal, October 2, 1886, p. 626. 

" For the Caesarean section two very powerful arguments may be advanced : 1. 
That the child is not sacrificed, and that it has a reasonable prospect of being. 2. 
That the mother has a reasonable prospect of being saved."— Barnes, British Medi- 
cal Journal, October 2, 18S6, p. 624. 



284 ESS A YS AND ADDRESSES. 

bility I quote from Barnes's summary of conclusions the fol- 
lowing four propositions. 1 (Italics mine.) 

1. " In the most extreme degree of pelvic distortion, when 
delivery per vias naturales can only be effected with doubtful 
success to the mother, Porro ? s operation is the legitimate alter- 
native of craniotomy, it being understood that the opportunity 
of inducing abortion has gone by." 

2. u In less advanced degrees of pelvic contraction, but 
still incompatible with the delivery of a living child per vias 
naturales, the opportunity of inducing abortion having gone 
by , but in which craniotomy would effect delivery with strong 
presumption of safety to the mother, the Csesarean section 
may be a proper alternative for craniotomy. This is the 
most debatable point." 

3. "In the minor degrees of contraction, say from three 
inches to three and a half and three-quarters inches, the oppor- 
tunity of inducing labor having gone by, the greater safety 
to the mother obtained by craniotomy, and the prospect of 
living children in future pregnancies by inducing labor, 
make craniotomy the proper course to pursue." 

4. " When obstruction is due to hydrocephalus or dropsy 
in the child embryotomy or tapping is indicated." 

The first of these propositions does not raise an issue with 
regard to pregnancies at full term. Tapping offers the best 
chance to such a life as that described in the last. The sec- 
ond is declared to be the most debatable, and might be left 
where its author puts it. For if the issue of safety to the 
mother by either of the operations is thus submitted to doubt, 
the ninety-six chances of saving the life of the child are suffi- 
cient to justify and determine the election of Cesarean sec- 
tion, which gives " strong presumption of safety to the 
mother." The third bases the decisive choice of craniotomy 
upon the hypothesis, before referred to, of possible " living 
children in future pregnancies by inducing labor." This 

' The other conclusions have been embodied in the preceding statement of limita- 
tion and facts. — British Medical Journal, October 2, 1886, p. 635. 



ESSA YS AND ADDRESSES. 285 

proposition was formulated when Porro's operation was con- 
sidered in contrast with craniotomy, and loses whatever force 
it may have then had in the fact that the improved Cesarean 
section had yielded a percentage of living children one and 
a half times greater than that of induced premature labor, 
and, besides, offers a higher percentage of " prospect of 
living children in future pregnancies " than induced labor. 
Dr. Barnes concedes the choice of induced premature labor 
to craniotomy when the child is living and viable. This 
concession is based upon the prospect of saving children that 
would necessarily be sacrificed by craniotomy. It logically 
follows, therefore, that when it can be shown, as it has been, 
that the improved section saves more children and offers better 
prospects in subsequent pregnancies than induced labor does, 
the reason for the only one of the three propositions which 
advocates the election of craniotomy disappears, and with it 
all justification based upon that reason. It is thus clearly 
shown that Barnes's admissions, in view of the more recent 
advances in obstetrical surgery, absolutely obliterate the field 
of its application as defined by him. 

The first proposition qualifies the choice of Porro's opera- 
tion in cases of " most extreme degree of pelvic distortion," 
and the second qualifies the debatable issue of election between 
section and perforation, in cases of " less advanced degrees of 
pelvic contraction," with the significant words, " the oppor- 
tunity of inducing abortion having gone by." By inducing 
abortion he means the arbitrary termination of the pregnancy 
before the period of foetal viability. So that practically the 
all-absorbing question of deliberate destruction of foetal life 
recurs with all its forbidden intent, and this in the face of 
the fact that craniotomy in the first class of cases (first propo- 
sition) is more destructive of maternal life than section was 
even before the discovery of Porro, or, still more, the favor- 
able improved method of Saenger. The acceptance and prac- 
tice of the alternative of induced abortion would constitute a 



286 ESSAYS AND ADDRESSES. 

barrier to progress and relegate obstetric surgery to the epoch 
which its author has characterized as brutal. 

To bring the issue more closely to a final result I invite 
your attention to the analysis and comparative results 1 of 
Cesarean section, induced premature labor, version, and 
perforation in all cases of contracted pelvis, performed in the 
Dresden clinic during the four years ending December, 1887. 

Total maternal mortality from 

Induced premature labor . 2.2 Perforation 2.8 

Version and extraction . .4.8 Csesarean section . . . . 8.6 

Mortality from sepsis : 

Induced premature labor . 2.2 Perforation 0.0 

Version and extraction . . 0.0 Csesarean section .... 4.3 

Percentage of children discharged living: 

Induced premature labor . 66.6 Perforation 00.0 

Version and extraction . . 59.0 Csesarean section .... 87.0 

Or, to state the result in aggregate, as follows : 
Percentage of children discharged living and mothers saved: 

Induced premature labor .... 66.6 children. 97.8 mothers. 

Version and extraction .... 59.0 " 95.2 " 

Perforation 00.0 " 97.2 " 

Csesarean section 87.0 " 81.4 " 

Or stating the aggregate saving of life by each operation, 
two hundred lives being involved in every one hundred cases: 

Induced premature labor . 164 Perforation 97.2 

Version and extraction . . 154.2 Csesarean section .... 178.4 

The foregoing figures present the alternatives of Csesarean 
section in their most favorable aspect. The ratio of maternal 
mortality in craniotomy is 2.8 per cent., and yet nearly twice 
as many lives are saved by section. Nor should we overlook 
the facts that one-half of the maternal mortality of Csesarean 
section was due to causes beyond the control of the operation, 
and that in every case a living child was delivered. 

The statistics show that craniotomy saved 5.6 per cent, 
more mothers than section, but the latter operation offsets 

1 Review of contributions of Korn, Lohman, and Prager. Edited by Leopold. 
American Journal of Obstetrics, vol. xxi. p. 671. 



ESSAYS AND ADDRESSES. 287 

this small increased loss of mothers by giving us all the 
children living at delivery and 87 per cent, of them alive 
at the time of discharge from the clinic. The issue then re- 
solves itself into the simple question of the actual or relative 
value between the lives of five or six women and eighty- 
seven children. If we base our conclusion upon the univer- 
sally accepted apothegm that li that only is right which 
produces the greatest good to the greatest number," the con- 
clusion is self-evident — the eighty-seven must be saved; and 
this conclusion is reinforced by the fact that the five or six 
lives lost are those of women who cannot give birth to a 
living child per vias naturales. If there is any obligation 1 
of duty or maxim of the moral law which demands the sacri- 
fice of eighty-seven lives to improve the prospects of saving 
five or six women in labor, the time had surely come for its 
abrogation. But the argument ad hominem replies with the 
specific citation of the daughter or wife of some high official, 
conspicuous in social life, possessing marked beauty and in- 
telligence, with ample wealth which she devotes to charity 
and benevolence, and holding in her physique and constitu- 
tion the highest probability of a long and useful life, and 
demands to know if the life of such a woman should be sub- 
mitted to the 5.6 per cent, chances of death, with the 87 per 
cent, chances of life to her child, rather than the 2.8 per 
cent. 2 chances of death with the deliberate killing of her 
child. The picture is pathetic and moving, but the answer 
is simple and plain. Both science and religion deal with 
exceptional cases as such. The broad principles of truth, 

1 " How long must we be forced by lay opinion to destroy the lesser for tbe benefit 
of tbe greater life, wben it can be conclusively sbown tbat tbe Csesarean section, 
resorted to in time, may witb almost absolute certainty result in tbe saving of two 
lives?" — American Journal of Obstetrics, vol. xxi. p. 672. 

2 A later abstract (American Journal of Obstetrics, vol. xxi. p. 779) of a paper by 
Wyder (Arcbiv f. Gyn., vol. xxxii. i.) states tbe maternal mortality of craniotomy 
and induced premature labor, at tbe clinics of Berlin, Halle, and Leipzig, as follows : 

Berlin, 104 cases of perforation 5.8 per cent. 

Halle, 35 " 5.7 

Leipzig, 76 " " 5.3 " 

Premature labor: 306 cases; mortality . . . .3.9 " 



288 ESSAYS AXD ADDRESSES. 

humanity, progress, and development are not to be stayed or 
hindered by the special pleading of imaginary cases of isolated 
hardship, however much of pathos or tears they may suggest. 
All lives are of equal value in the eyes of the true scientist 
and the true Christian, and the divine art of healing can 
have no safer guide than this : That nothing can possibly 
justify the taking of a human life unless it be the absolute 
certainty that, by this means alone, another human life can 
be preserved — and this is the answer of both religion and 
science. 

It is true that the ratio of mortality is less, but the uncer- 
tainty of life remains the same. Each woman operated upon 
by either method takes all the risks of the operation. Those 
dying after craniotomy might have been saved by section, 
and vice versa. The saving of the child is the only compen- 
sation for the uncertainty of life and possible error of elective 
procedure. The unflinching discharge of unavoidable duty 
is the only guide of conduct. The behests of a long-accepted 
dogma should not thwart the progress of science which prom- 
ises divorcement of the profession from lay opinion, which 
claims the destruction " of the lesser for the benefit of the 
greater life." 

The right of an individual to select the alternative of cer- 
tain death rather than submit to an operation which may 
shorten, but more probably will effect a cure and prolong 
life, is not absolute. In such case, but one, and that the 
life of the victim, is involved. Such right cannot, however, 
be conceded to a woman in labor who is responsible for the 
existence of her child and the danger of both, since by it she 
imposes upon an innocent operator the act of killing that her 
prospect of life may be slightly improved. The conviction of 
right in the first cannot carry with it the concession of right 
in the latter instance. 

If a pregnant woman possesses the natural and inalienable 
right to terminate the life of her child at term, she cannot be 
denied the right to terminate it at any period of gestation, 



ESSAYS AXD ADDRESSES. 289 

and criminal abortion would then become an accomplishment 
of the highest significance. The early destruction of embry- 
onic life would be the simplest and surest escape from the 
perils of utero-gestation and parturition ; would effectually 
withdraw from farther scientific pursuit the advances in 
obstetrics which seek the elimination of craniotomy ; more 
certainly extinguish the instincts and attribute of maternity ; 
nullify the laws of reproduction ; and reduce woman to a 
level more degrading than any to which the most barbaric of 
primitive people consigned her. 

The argument that craniotomy upon the living and viable 
foetus is the indirect killing of an unjust aggressor is a trivial 
sophism. The killing is the immediate and even more direct 
object than the end sought to be accomplished, for that is 
necessarily attended with the chance of safety to the mother. 
It is a curious but interesting historical fact that embryotomy 
found its beginning in the intuitive obstetric practice of primi- 
tive peoples/ who believed that all difficulties were referable 
to the evil disposition of the child, and that " a child so 
perverse as to refuse absolutely to appear deserved death, as 
did the mother who carried such a child." Obstetrics has 
advanced from the epoch of intuitive practice, through the 
religious and pre-anatomic epochs and the first three hundred 
and fifty years of the scientific period, and yet there are very 
many eminent obstetricians practically holding fast to the doc- 
trine of merited death or justifiable killing of the foetus for a 
like cause and a like method, which the primitive peoples 
could justify only upon the theory of the evil disposition, 
perverseness, and unjust aggression of the unconscious and 
passive child. Nevertheless, the savage inhumanity of such 
a doctrine evinces a broader sense of justice than is exhibited 
by the craniotomists of to-day, in that it recognized the culpa- 
bility of the mother to be equal with that of the child. 

It will be charged, notwithstanding the equally favorable 

1 Engelmann : System of Obstetrics, by Hirst, vol. i. p. 25. 
19 



290 ESSAYS AND ADDRESSES. 

results of craniotomy, that the maternal mortality of the alter- 
native procedures in the Dresden clinic are less than the ratios 
of mortality of the operations in general. The utmost fair- 
ness, therefore, requires that comparative ratios shall be 
obtained from large numbers, which will comprehend the 
experieuce of numerous operators. To this end the follow- 
ing analyses are made : 

In a private letter, dated August 20, 1888, Dr. K. P. 
Harris informs me that 131 improved Cesarean operations 
had " been performed in 11 countries by 73 operators, with 
a saving of 95 women and 118 children." 

In 15 German cities, 32 men had had 65 cases and saved 
56, a percentage of 86f ; only 9 deaths in all. 

In 5 Austrian cities, 7 men operated 21 times, saving 15, 
or 71f per cent. 

In 9 American cities, 16 men operated 20 times, with 9 
saved, or 45 per cent. The first 5 were all fatal. 

Russia saved 4 out of 6 ; Holland saved 4 out of 4; France 
saved 2 out of 4 ; Italy saved 2 out of 4 ; Switzerland saved 

1 out of 2 ; India saved 1 out of 2 ; England saved out of 

2 ; Denmark saved 1 out of 1 ; 71 saved out of first 100 ; 
33 saved out of first 50; 38 saved out of second 50 ; 34 men 
saved out of 45 cases, in 1887, 36 women, or 80 per cent. 

This aggregate in its most unfavorable aspect, with its 73 
operators in 11 countries, and including the educational and 
experimental cases in this country, shows a saving of 72. 52 
per cent, of women and 90.84 per cent, of children. In other 
words, it shows a saving of 165.36 lives out of a possible 200, 
being 65.5 more lives saved than is possible by craniotomy, 
even admitting that it is absolutely free from danger to 
women. As yet, no one has claimed that any group of 73 
craniotomists has saved 100 per cent, of the lives of the 
women operated upon, even though they sacrificed 100 per 
cent, of the lives of the children. Further comment is un- 
necessary. 

Later statistics: Caruso (Archiv fiir Gyndkologie, Band 



ESSAYS AND ADDBESSES. 291 

xxxiii. Heft 2) has collected the cases of the modern Cesarean 
section up to October 1, 1888, " comprising 135 cases; 6 
successful cases, in addition, are known to Caruso, but the 
details necessary for publication were lacking. 

' ' German operators have performed 74 of these operations ; 
Americans, 18; Austrians, 16; the results by Americans are 
inferior to those of the Germans and Austrians. The results 
are 74.44 per cent, of recoveries among mothers in all cases 
aud 91.73 per cent, recoveries among children; in three cases 
in which the operation was done a second time both mothers 
and children recovered. It may, therefore, be said that a 
mother has three chances out of four and her child nine out 
of ten for life with this operation. 

" A careful estimate of the results of craniotomy under 
antiseptic precautions shows that 93.4 per cent, of the 
mothers recover. Selecting similar cases on which section 
was performed, the percentage of recoveries in these cases 
was 89.4, and 100 per cent, of children. Caruso concludes, 
therefore, that craniotomy on the living foetus is to be super- 
seded by the conservative operation/' 



THE HOSPITAL FOE CONTAGIOUS DISEASES. 

LETTER ADDRESSED TO THE COMMISSIONERS OF THE 
DISTRICT OF COLUMBIA, JUNE, 1893. 

Preliminary to the selection of a site, adoption of 
plans, and construction of the buildings, the Commissioners 
should determine the forms of disease to be admitted. Pre- 
sumably the three most prevalent and dangerous forms — 
diphtheria, scarlet fever, and measles — would be named. 
Typhoid fever and venereal diseases can be as well and 



292 ESSAYS AND ADDRESSES. 

perhaps better cared for in other hospitals. Mumps, chicken- 
pox, and whooping-cough are so rarely serious and are com- 
paratively so free from danger as not to need hospital accom- 
modations. Cholera, typhus and relapsing fevers are such 
infrequent visitors to this locality, the latter never having 
invaded this city, and the cholera not since 1832, that it 
would seem entirely unnecessary to consider them in connec- 
tion with this hospital. Smallpox is provided for. 

The diseases usually classed as contagious diseases, with 
the exception of smallpox, are far more prevalent among chil- 
dren under ten years of age. Therefore, it must follow that 
all institutions established for the care and maintenance or 
for hospital management and treatment of children under ten 
years of age, to which the immune aud susceptible are alike 
admitted, must always be liable to invasion when such dis- 
eases are prevalent in surrouDding or adjacent communities. 
Such institutions are not, however, more often or necessarily 
the original focus for dissemination than a focus invaded by 
dissemination from other foci in adjacence, proximity, or by 
conveyance, either direct by personal intercourse or indirect 
by infection of the atmosphere. In fact, every private resi- 
dence in every town and city in which are domiciled one or 
more susceptible persons, especially children under ten years 
of age, becomes during the prevalence of these maladies a 
focus inviting invasion, and when invaded a focus dissemi- 
nating the contagion. 

It is also well established that places, buildings, and in- 
stitutions where numbers of well but susceptible children daily 
or weekly congregate, coming as they usually do from locali- 
ties and many private residences of the same city, may con- 
stitute foci for the dissemination of contagious diseases of far 
greater frequency and wider prevalence than the hospitals, 
where only the victims are admitted and detained in quaran- 
tine until all danger of infection has passed. In fact, all 
schools, public, private, and parochial; picnics, garden-par- 
ties, social entertainments, amusements of all kinds, and 



ESSA YS AND ADDRESSES. 293 

funerals of those dead of the disease, where well, but suscep- 
tible, children may assemble may constitute foci for the dis- 
semination, of any of the diseases known as contagious and 
infectious, when the disease is present in the locality, district, 
or houses from which the children may come. In any such 
assemblage more children may be infected and wider spread 
epidemics may find their beginning than could be traced to a 
properly constructed and managed hospital filled to its utmost 
capacity and located in close proximity to the most densely 
populated parts of any city. It is not improbable that the 
conveyance of the victims through the streets of a city to a 
hospital remotely located from the mass of population would 
be even more dangerous (certainly to the patients) to the 
community than the hospital could be, even though located in 
the very midst of the most thickly populated part of the city. 

Epidemics of contagious diseases vary in prevalence, in- 
tensity, and mortality. During such epidemics many suscep- 
tible persons escape. Those escaping may reside in the same 
block, on the same square, on opposite sides of the same street, 
in adjoining and even in the same house with the victim. 
Such epidemics are far less prevalent in this than in other 
cities because of the greater width of the streets and avenues, 
numerous parks and unoccupied spaces, consequent freer ven- 
tilation, dilution and diffusion of the poison. 

All hospitals for the treatment of sick children are liable 
to invasions of contagious diseases when such diseases are 
prevailing in the community contiguous thereto, and in many 
of such hospitals wards are provided for the isolation of such 
cases. In some these wards are in the hospital-building, but 
most frequently they are outside of the hospital-building in 
the inclosure in near proximity to the other buildings and 
under the hospital management. As yet, it has not been 
shown that such arrangement for the care and treatment of 
contagious diseases has proved detrimental to the health of 
susceptible persons in adjacent and contiguous parts of the 
city, nor has it been claimed that such institutions have 



294 ESSAYS AND ADDRESSES. 

become foci for the dissemination of such diseases. In fact, 
the explosions of contagious diseases in hospitals for sick chil- 
dren have usually been traced to the admission of visitors 
from infected houses and districts. 

The fact has been established by the investigations of the 
highest German and English authorities that hospitals for 
diphtheria, scarlet fever, and measles located 300 feet from 
inhabited houses are absolutely safe. 

It may be asserted without fear of contradiction that not 
one case of either of these diseases has been traced to a prop- 
erly constructed and managed hospital for contagious diseases 
located 300 feet distant. In many cities in this country and 
abroad they are located much nearer. 

The foregoing is a simple statement of the conditions, 
circumstances, and facts relating to the selection of a site 
for the hospital, and lead to the conclusion that it might be 
located upon any unoccupied square or reservation within 
the limits of the city without detriment to the health of the 
surrounding population or injury to commercial interests be- 
yond that pertaining to every eleemosynary institution and 
hospital. 

A hospital for contagious diseases, separate and distinct 
in its management, will prove to be an expensive establish- 
ment because of the necessity of continuous complete equip- 
ment for every emergency. The occurrence, prevalence, and 
succession of epidemics or sporadic cases cannot be predeter- 
mined. Past experience would point to the conclusion that 
for the greater part of each year in the near future there 
would not be any patients. The hospital must be kept in 
readiness for patients ; patients cannot be made for the hos- 
pital ; convenience, economy of administration and equip- 
ment, as well as humanity, would, therefore, locate the estab- 
lishment in safe proximity to some well-conducted and 
equipped hospital and place its management under the direc- 
tion and control of the same, so that the current expenses 
when idle would be reduced to the minimum, and as the 



ESSAYS AND ADDRESSES. 295 

necessities increase all stores, hospital-supplies, nurses, and 
medical care could be obtained from the institution in 
control. 



THE MEDICAL SOCIETY OF THE DISTRICT OF 
COLUMBIA. 

ADDRESS OF THE PRESIDENT AT THE SEVENTY-FIFTH ANNI- 
VERSARY OF THE MEDICAL SOCIETY OF THE 
DISTRICT OF COLUMBIA, DELIVERED 
FEBRUARY 16, 1894. 

Ladies and Gentlemen : Inasmuch as the occasion 
which has brought us together to-night is one of those his- 
toric events which emphasize the permanency of this city 
as the capital of a great and powerful nation, and, following 
so quickly the commemoration of the centennial anniversary 
of the laying of the corner-stone of the Capitol, identifies the 
history of medicine with that of the city from its foundation 
to the present time, I will venture to recall your attention to 
such historic data as will establish the coincident relation of 
the medical profession in this city with its early history, 
development, and present prosperous condition. 

On the 9th of July, 1790, Congress passed, and on the 
16th of the same month Washington approved, the Act 
" establishing the temporary and permanent seat of the 
government of the United States on the River Potomac." 
In March, 1791, Washington issued a proclamation defining 
the limits of the new federal territory and directing the com- 
missioners and engineer to proceed with the preparation of 
the plan of the government city. On the 18th of September, 
1793, the corner-stone of the Capitol was laid by Washing- 
ton, and on the third Monday of November, 1800, the Con- 
gress of the United States began its first session in the Capitol 
in this city. 



296 ESSAYS AND ADDRESSES. 

When Drs. Samuel Brown and John Crocker settled here 
" the territory was inhabited by a few farmers, their servants, 
and perhaps some tradesmen and fishermen." 1 With the set- 
tlement of Frederick May, a native of Boston and a graduate 
of Harvard University, in 1 795, medicine as a science had its 
beginning in the city of Washington. Others followed, and 
in 1815 there were nine physicians and two practising apothe- 
caries. 2 The first associate assemblage of physicians of this 
city took place in 1813, called by public advertisement, " to 
take suitable notice of the death of Dr. Benjamin Rush," the 
father of American medicine, and " to appropriately com- 
memorate his life and professional services." 3 

Perhaps prior, but certainly during several years succeed- 
ing this date, the influx of charlatans and pretenders was so 
extraordinary, and such injuries and wrongs were perpetrated 
by them upon citizens, that the qualified physicians began to 
consider and discuss methods of procedure and organization 
by which the community could be protected from such wrongs 
and informed of the qualification of those fitted to practise 
the healing art. Those efforts culminated in a petition to 
Congress in 1818, signed by twenty-one physicians, for the 
charter, which was granted and approved by President Mon- 
roe on the 16th of February, 1819. 

We have invited you here to-night to unite with us in 
commemoration of that event. And now that you know 
that those noble founders were animated by the highest 
inspiration of Christian philanthropy and beneficence in 
the foundation of a medical society which has lived through 
a period of seventy-five years, contemporaneous in history 
with the federal city aud the government, you will appre- 
ciate and honor the pride we take in giving expression to 
our praise and gratitude in memory of those noble men on 
this anniversary-night. 

From twenty-one it has grown to an active resident mem- 

1 Anniversary address, by Dr. J. M. Toner, September 26, 1866. 2 Ibid. 3 ibid. 



ESSAYS ANJD ADDRESSES. 



297 



bership of two hundred and fourteen, of whom but three 
have passed the age of allotted lifetime, and its senior in 
membership is a decade younger than it. I need not, then, 
tell you that in physical vigor and intellectual alertness it is 
now in the very prime of mature life. 

Such youth and vigorous manhood have not always char- 
acterized its membership. The average age has diminished 
with time and the increase of numbers. Anions the honored 
dead twenty-eight 1 lived beyond threescore and ten, of whom 
six were founders; nineteen died at ages between fifty and 
sixty-three years after the date of graduation; and seven 
held continuous membership in this Society for periods of 
fifty to sixty-three years. 

The average age of those venerable decedents was seventy- 



(M 








No. of 


Xo. of 






Date of 


Date of 




rears 


rears 






admis- 


gradu- 


Date of 


living 


of con- 






sion to 


ation in 


death. 


after 


tinuous 


Founders. Age. 




Society 


medicine 




gradu- 
ation. 


mem- 
bership 




Antisell, Thomas 


1859 


1839 


1893 


54 


34 


76 


Blake. John B. 


1826 


1824 


1881 


57 


85 




81 


Bohrer, B. S. 


1817 


1810 


1862 


52 


45 


Founder. 


77 


Borrows, Joseph 


1838 


1828 


1889 


61 


51 





82 


Catbush, Edward 


1820 


1794 


1843 


49 


23 





71 


Condit, H. F. 


1838 


1830 


1893 


63 


55 





89 


Dawes. Frederick 


1838 




1882 








74 


Dick, E. C 


1817 


1782 


1825 


43 


8 




75 


Fairfax, Orlando 


1S30 


1829 


1S82 


53 


51 




76 


Hall, J. C. 


1838 


1827 


1880 


53 


42 




75 


Howard. F. 


1842 


1841 


1888 


47 


46 




77 


Jones. William* 


1817 


L.M.C.F. 


1867 


50 


50 


Founder. 


77 


Johnson, Richmond 


1834 


1826 


1874 


48 


40 


1 83 


Lieberman. C. H. 


1>44 


1836 


1886 


50 


42 


74 


Lindsler, Harvey 


1834 


1828 


1889 


61 


55 


85 


Magruder, Hezekiah 


1S50 


1826 


1874 


48 


24 




70 


Mav, Frederick 


1817 


1795 


1847 


52 


30 


Founder. 


74 


May, J. F. 


1S40 


1834 


1S91 


0/ 


51 




80 


McWilliam, Alex. 


1817 





1S50 




33 


Founder. 


75 


Patze, Adolphus 


1864 


1838 


1SS6 


48 


22 




82 


Riler. Joshua 


1827 


1824 


1875 


51 


48 




75 


Ritchie. Joshua 


1840 


1839 


1887 


46 


47 




72 


Tyson, S. E. 


1848 


1832 


1883 


51 


35 




74 


Tvler, Grafton 


1846 


1833 


18S4 


51 


38 




73 


Walsh, Joseph 


1843 


1S43 


1879 


36 


31 


73 


Warneld, P.* 


1817 


L.M C.F. 


1856 




39 


r ounder. 76 


Worthingtou. C. 


1817 


17S2 


1836 


54 


39 


Founder. 77 


Young, Noble 


1838 


1828 


1883 


55 


45 


,D 



* Licentiate of the Medical and Chirurgical Faculty of Maryland. 



298 ESSAYS AND ADDRESSES. 

six and one-half years, the youngest of whom died at seventy, 
in 1874, and the last at eighty-nine, in 1893. In the primi- 
tive era of medicine in this city and during the early history 
of this Society the life of the general practitioner could not 
have been less arduous than since. Many of them began 
life when the practice of medicine was primitive and unre- 
munerative in a community struggling with poverty in the 
development of a new city. It is true that the average life- 
time of the medical is much less than of either the legal or 
the clerical profession, but this general law of vital statistics 
fails to explain the average youth of the present membership, 
which represents five of the eight decades of the life-history 
of this Society. These data are somewhat phenomenal, and 
perhaps without special significance ; nevertheless, they em- 
phasize the fact that the pursuit of the art of healing is not 
conducive to longevity, and, while the average life of men 
in general is increasing, that of the medical profession is de- 
creasing. With an average age of forty-three and one-half 
years, and a prospective death-rate of 57 per cent, under 
sixty-five, the problem of life and longevity is of sufficient 
magnitude to command your attention. It will not do to 
ascribe this high death-rate during the prime of life and 
manhood wholly to mental worry, sleepless tire, and inade- 
quate remuneration, for these find compensation in the 
assured livelihood, conscious pleasure, and consolation of 
duty well done. Whether referable to such aesthetic or to 
graver considerations, the time has surely come when the 
causes of the comparative low average life of men engaged in 
the science of saving and prolonging life should be intelli- 
gently and definitely ascertained. Those few- — thirteen in all 
— who have reached and passed the age of highest death-rate 
are equally sure of the inevitable, but can offer their juniors 
the consolation of their good-wishes. 

The elder May came here in 1795, five years before the 
transfer of the government to this city. He was a pioneer 
who prepared the way for others, and the founder through 



ESSAYS AXD ADDRESSES. 299 

whose professional life the history of medicine in this city 
during the years antedating the organization of this Society 
can be traced through membership to and before the estab- 
lishment of the government here and continuously with its 
growth and development down to the present time. His 
son, John Frederick, was born and began the practice of 
medicine in this city and died a member of this Society, at 
the age of eighty years, leaving a son, now an active resident 
member. In this family the continuity of membership has 
been unbroken from its organization to the completion of its 
seventy-fifth anniversary. This Society, then, claims a life- 
time beginning before the government at Washington and 
coeval with the foundation of the city on the River Potomac. 

The Medical Society of the District of Columbia is the 
youngest of twelve medical societies in this country now in 
existence which have reached and passed the seventy-fifth 
year of continuous active life, and is the oldest, if not the 
first, scientific body chartered by an Act of the Congress of 
the United States. Ten of its founders were natives of 
Maryland, four of Virginia, two of Massachusetts, two were 
born within the present limits of the District of Columbia, 
and of three the nativities are unknown. In personal lineage 
it is confined to three of the original thirteen States, but as a 
scientific body it claims ancestral descent from eleven progeni- 
tors, who are present by representation with us to-night. It 
is, however, the natural and direct heir of the Medical and 
Chirurgical Faculty of Maryland. 

With such an ancestry, dating back to 1766, during the 
period of colonial discontent and strife; a foundation spring- 
ing from the noble impulses of humanity and inspired by 
motives of high professional responsibility; fulfilling in its 
corporate capacity, throughout its long life, the charter-decla- 
ration to promote and disseminate medical and surgical knowl- 
edge, and keeping abreast with the progress of a science which 
has made medicine the handmaid of religion, do you wonder 
that the successors of those who gave birth to this Society, 



300 ESSAYS AND ADDRESSES. 

now living in a community representing the intelligence, 
civilization, progress, and power of a nation of sixty-five 
millions of free people, should invite you to this reunion to 
tell you how faithfully they have kept the promise of its 
founders, and to unite with them in giving thanks and praise 
to that Providence which rules the universe ? 

The period comprising the years from 1819 to 1894 has 
been one of marvellous progress in science, literature, art, 
and in all that pertains to Christian civilization. The village- 
city with its domain of farms, scattered homes, graphic streets 
and avenues, " squares in morasses " and " obelisks in trees," 
has become the metropolis of a munificent nation, under whose 
supervision it has grown into a city surpassing in beauty and 
rivalling in attractiveness the more favored cities of both the 
old and the new world, and holding together in one com- 
pact community a cosmopolitan population, where education 
and culture need neither the blazonry of titular insignia, the 
heraldry of ancestral distinction, nor the glamour of wealth 
to command position and influence. 

During the same period medicine, here and elsewhere, 
advancing along the lines of pathological research and physio- 
logical therapeutics, has escaped the era of hypothesis and 
speculation, and now as a science of precision and demonstra- 
tion commands the respect and homage of the civilized world. 
Now, as heretofore and everywhere, it is foremost in charity, 
unselfish in devotion to the welfare of public health, mag- 
nanimous under public and private wrongs, and generous to 
a fault in unremunerative perils and responsibilities. 

But even this is not the full measure of its philanthropy. 
The mission of preventive medicine and sanitary science will 
not be attained until the causes of disease are eradicated and 
death is limited to the ailments to which flesh is necessarily 
heir and the processes of natural waste and decay. How 
soon, if ever, this may be accomplished remains with the 
laity ; medicine will continue the pursuit with the zeal and 
courage of a science which seeks the welfare of mankind 



ESSAYS AND ADDRESSES. 301 

rather than place and fortune. The medical is the only 
profession, trade, or occupation which seeks, by the progres- 
sive attainment of its ultimate object, the continuous decrease 
of emolument. 

One of the most pleasing incidents of this occasion is the 
presence of representatives of the eleven ancestral societies, 
the oldest of which was organized in 1766, in the State of 
New Jersey. This exhibition of fraternity is an exemplifi- 
cation of that beneficent spirit which dominates the medical 
profession and makes kindred of us all. 

Honored colleagues who will follow me will tell you of its 
achievements in science and of its educational and charitable 
foundations. I have only to conclude with a few words 
addressed to my colleagues and juniors. 

It could not have occurred before, and never can occur 
again, that the senior in membership will be unanimously 
re-elected to the presidency on the forty-fifth anniversary of 
his membership and preside at the commemoration of the 
seventy-fifth anniversary of this Society. Such a unique com- 
pliment cannot be acknowledged in words which will com- 
pletely and fittingly convey the gratitude I feel for such 
expression of personal and professional regard. At the cen- 
tennial reunion some one of you will stand where I now 
stand, upon whom will devolve the duty which thrills me 
with pleasure to-night. In the enforced retirement which 
must come soon, I will cherish the hope that each one and 
all of you may live to celebrate the golden wedding-day of 
professional life, and in communion with the Saviour of man, 
who was first to heal the lame, the halt, and the blind. 

AFTER-DINNER SPEECH AT THE BANQUET, 
FEBRUARY 16, 1894. 

Gentlemen : In the olden time, during the period of 
primitive medicine and embryotic condition of this city, 
about the time when Tom Moore, in his rhapsody on the city 
and national government, wrote: 



302 ESSAYS AND ADDRESSES. 

" In fancy now beneath the twilight gloom, 
Come, let me lead thee o'er this ' second Rome,' 
Where tribunes rule, where dusky Davi bow, 
And what was Goose Creek once is Tiber now : 
This embryo capital, where fancy sees 
Squares in morasses, obelisks in trees ; 
Which second-sighted seers e'en now adorn 
With shrines unbuilt, and heroes yet unborn, 

Though naught but woods and J N they see, 

Where streets should run, and sages ought to be." 

The nine physicians and two practising apothecaries, to- 
gether with others from Georgetown and Alexandria, held 
their business meetings in the hostelries of that early date 
known as Tennyson's and Strother's taverns. If they ever 
assembled in social reunion, our distinguished historian, Dr. 
Toner, has failed to inform us ; but we do know there was 
no banquet-hall in which, like ourselves, they could assemble 
to greet and bid welcome their friends and each other around 
the festive table. How different now ! Seventy-five and more 
years have passed, and we have come together in number ten 
times more to bid welcome to guests from different places, 
together with others from our midst, and to make merry our- 
selves in a reunion of reason and flow of soul. While bowing 
in profound sorrow for those who have gone before, we rejoice 
in being among the living to-day, in that we may commemo- 
rate their good deeds and virtues in seeking relief from dull 
care, weary toil, and sleepless vigilance, in pastimes and pleas- 
ures and " learn the luxury of doing good." And if Tom 
Moore, with his good friend, Thomas Hume, in the rugged 
days of yore, could 

Sit at evening tide beneath the western stars, 
Softly sigh, like lovers, through their sweet cigars, 
And fill the ears of some consenting she 
With puffs and vows, with smoke and constancy, 

why may not we, in the hour of our triumph, though old in 
years but young in flesh, bid our sorrows ' ' a brief farewell," 
and with 

" Pleasure aud action make the hours seem short " 

while we 

" Sit to chat as well as eat " 



ESSAYS AND ADDRESSES. 303 

in social reunion with our guests, who have brought with them 
the paternal and fraternal congratulations of our sires and 
brothers, and join with us in making active and giving 
spirit to the hopes of a future more brilliant than the past ? 

For these opportunities we owe a debt of lasting gratitude 
to the city of our home and the government under which we 
live. With their progress and development we have grown 
in number and power. Under the fostering care of the 
general and municipal governments and energy of its citizens 
this city of the nation and heart of its political life has become 
the most desirable city of residence in this great and populous 
country. The inchoate village of a century ago, now a city 
with its beautiful streets and avenues, flowing fountains, and 
decorated parks which adorn the landscape at every turn with 
flowers, foliage, and sward, is but the promise of what it is to 
be in the future. And now let us, here assembled in loving 
gratitude, plight the best energies of our lives and services in 
promotion of its healthfulness and the welfare of its citizens. 

Just seventy-five years ago this Society held its first meet- 
ing in the council-chamber of the city, and thereby plighted 
their faith ro live together as mutual helpmates of each other. 
I rejoice that it has fallen to my lot to proclaim here, in the 
presence of both contracting parties, on this diamond wedding- 
night, that the promise has been kept. I know not which 
was the bride nor which was the groom on that auspicious 
occasion, but for the present I yield the role of the better- 
half to my friend on my left, the Honorable John W. Koss, 
President of the Board of Commissioners of the District of 
Columbia. 



304 ESSAYS AND ADDBESSES. 



ASSOCIATION OF MILITAKY SUKGEONS. 

ADDRESS OF WELCOME TO THE ASSOCIATION OF MILITARY 
SURGEONS, DELIVERED AT WASHINGTON, MAY 1, 1894. 

Mr. President and Gentlemen: I am here, as the 
representative of the Medical Society of the District of 
Columbia, to extend to you the right hand of fraternal 
fellowship and comity of a society which is one of twelve 
medical societies in this country that have passed the age 
of seventy-five years in active and continuous existence, 
and to bid you welcome to the city of its birth, in which 
it has lived these many years, contemporaneous in history, 
progress, and power with the growth, development, and 
prosperity of this metropolis, and now, as heretofore, com- 
mands the respect and confidence of the community. Its 
beginning was inspired by that spirit of beneficence which 
bouud its founders together in one compact body of such, 
and only such, physicians as were qualified to practise the 
healiug art and to promote and disseminate medical and sur- 
gical knowledge, that the people might be protected from the 
wrongs and injuries inflicted by charlatans and pretenders. 
Throughout its long life it has accepted, maintained, and 
followed the maximum of the Eepublic — " Uniou, now and 
forever, oue and inseparable' 7 — as alike applicable to the 
advancement of scientific medicine as to the maintenance of 
the union of these States. With firm, steadfast, and un- 
wavering devotion to the highest aims of medical science, it 
has successfully passed through many vicissitudes of political 
agitation, bid defiance to assaults from without, and outlived 
schisms in its own membership. 

It passed through the period of internecine strife and 
emerged from that conflict of havoc, bloodshed, and waste 
of treasure increased in number and power, and stands here 



ESSAYS AND ADDRESSES. 305 

to-day to bid welcome to this organization, which is the out- 
growth of that development, and the first to unite in organized 
and cohesive effort to utilize, promote, advance, and perfect 
the science of military medicine and surgery ; and let it be 
said here and now that if those armies could have been 
equipped with such men and appliances as they could be to- 
day, the missiles of warfare would have found many thou- 
sands less of victims, and untolds millions of treasure 
would have been saved. The war gave impetus to new 
thought, to new and broader conceptions of military duty, 
and the achievements of modern American surgery owe their 
inception to the opportunities and lessons which you and others 
have expanded and applied in the interest of a common hu- 
manity. And now this country holds the sceptre of surgery. 
In 1858 the lamented Harvey Lindsley, in his address of 
welcome to the American Medical Association, then assem- 
bled in this city, after giving expression to his regret and 
mortification that the city was so barren of all that would 
interest the votaries of medical science and attract the 
pleasure-seeker and tourist, he added, in language that 
reads like the inspiration of prophecy, " the day is not 
far distant . . . when by the liberality of a great 
people our public buildings, our literary and scientific in- 
stitutions, our national parks and botanic gardens will be 
worthy of the grand metropolis of a nation which, perhaps 
within the next half-century, will be the most populous, 
powerful, and wealthy in Christendom." I heard those 
words thirty-six years ago, and I stand here to-day, repre- 
senting the same organization, to bid you welcome to the 
Capital, in which every prediction has been realized, and 
yet it has but reached the stage of growth and development 
which is but the promise of what it is to be in the future, 
when, as the nation's Capital, reflecting its power, glory, 
and wealth, it will surpass in all that pertains to art, litera- 
ture, science, civilization, and human comforts and luxuries 
the most favored metropolis of the civilized world. 

20 



306 ESSAYS AND ADDRESSES. 

That you may better appreciate the modesty of Lindsley's 
description and the fulness of his prophecy, let me tell you 
that when I came here, some years earlier, there were but 
two streets partly paved, but few sidewalks paved beyond 
the centre of the city, they being, for the most part, improved 
by midway ridges of gravel and coal-ashes, but there were 
long stretches of zigzag paths along which pedestrians could 
walk only in single file. There were no telephones, street 
tramways, nor cable and trolley systems of rapid transit to 
fill the wards of an emergency hospital and encourage the 
incidental sciences of embalming and undertaking; street- 
transportation was limited to a few hotel omnibuses, through- 
line coaches, a few hackney carriages, a corps of night-liners, 
as now, and Shank's mare. From the capital to Georgetown 
several antiquated buses ran at irregular intervals along 
Pennsylvania Avenue. The fare for a ride each way for 
each passenger was one eleven-penny bit, but a colored nurse 
or maid could not get a ride at any price unless she had some- 
body's white baby in her lap. 

The back yards of many private dwellings were decorated 
with pigstys, cowsheds, and pens for the gangs of unyoked 
geese. During the day the animals and fowls roamed at 
will, singly or in herds or flocks, through the streets and 
over the fields in lordly insolence. Garbage was thrown 
into the carriageways or back alleys, and swine were 
the privileged and protected scavengers. To jostle against 
or drive over one of these municipal functionaries, when 
out on his tour of sanitary inspection, incurred a cash 
penalty or brief servitude in the workhouse. The swine- 
nuisance dominated the city authorities until a gentleman 
was knocked down and killed by one running between his 
legs, and the family milch-cows were finally driven to the 
shambles by the more economical and adulterated milk-sup- 
plies from the dairy-farms of Maryland and Virginia. The 
goose-industry bade defiance to every protest until the robber- 
bands learned the flavor of their flesh. During that early 



ESSAYS AND ADDRESSES. 307 

period I have trudged on foot, through sunshine and shower, 
along the well-beaten paths for short-cuts across the fields 
aud through the slashes, in search of some lonely hut situated 
over yonder behind or near by some other equally undefined 
locality, here aud there, along the way, driving a drove of 
swine from their mire or hustling away from the corporation 
bulls, or duriug the night along streets, alleys, and by-ways 
so dark with blackness that eyes were most useful when 
closed, or so dimly lighted with lard-oil lamps so remotely 
separated they seemed like ignis fatui enticing one into the 
dismal realms of hobgoblins and ghosts ; or, perchance, in 
some localities — now traversed by well-paved streets and 
avenues adorned on either side with palatial residences — 
along the pathways trodden only by the beasts of the field. 

Then the war came, and with it a transformation not less 
surprising than the primitive methods and conditions to 
which I have referred. The barren farm- and pasture-lands 
were occupied with encampments, fortifications, parade- 
grounds, hospitals, wagon-yards, mule-pens, and other mu- 
nitions of warfare. The streets were in continuous martial 
array with troops equipped for the field. In brief, the 
city was one great, impregnable fortress, protecting a gov- 
ernment that never for one moment faltered in courage or 
paused in prosecution. With these stupendous preparations 
and masses of troops there came the omnium gatherum of 
contrabands, refugees, scalawags, camp-followers, tramps, 
substitute - brokers, wildcat - money - changers, fiat - money 
people, office-seekers as now, and last, but not least, the 
croakers who lived upon the innocent credulity of timid 
women and cowardice of malingerers who wanted war but 
somebody else to do the fighting. The croaker tarries with 
us yet and continues, like " querulous frogs in muddy pools," 
to croak. Nevertheless, those of you who saw the city then 
will mark the contrast now. Peace reigns where martial 
law dominated. Progress and development have marked 
every decade of the city's history since the close of the war. 



308 ESSAYS AND ADDRESSES. 

Now go where you may please along these beautiful streets, 
these avenues of foliage-trees, or out upon the hilltops that 
environ the city, and the prospect and landscape will leave 
the memory of beauty in nature and excellence in art. The 
monument in honor of him whose name the city bears rises 
from the lowlands high into the space above, as the nation's 
memorial to him who was " first in war, first in peace, and 
first in the hearts of his countrymen ;" the Capitol, in which 
assembles annually the highest tribunals of legislation and 
justice, stands, in beauty and perfection of architectural 
finish, above the rising and setting sun, in token of the 
supreme majesty of a united people; the new library-build- 
ing approaching completion, with its gold-gilded dome re- 
flecting and diffusing the rays of sunlight and sun-life in 
emblematic dissemination of the knowledge to be stored 
within its granite walls; the new naval observatory, far 
away from the busy mart and travel, toward the western 
limits of the city, is a fitting compliment to that branch of 
the service which in the coming future will make the nation 
the master of the seas; and right here in the open park, near 
by, the historic mansion, with its walls hanging in portrait- 
ure of the men who have filled the highest office in the gift 
of a great and free people; and then, too, on the highland 
beyond the Potomac, overlooking the city, is the bivouac of 
seventeen thousand dead, whose glory will never fade. All 
these, with many other commemorative memorials, are but 
the symbols of the nation's pride, wealth, gratitude, prowess, 
and majesty. 

I cannot detain you with an enumeration of the charitable, 
educational, and eleemosynary foundations which mark the 
progress since the development began ; but must broadly state 
that in learned and scientific institutions, departments, 
bureaus, and great national libraries, with their corps of 
experts in every branch of science, this city offers opportu- 
nities unsurpassed in any city in this country. With three 
universities fully equipped and in successful operation, 



ESSAYS AND ADDBESSES. 309 

another with ten millions of people behind it is preparing to 
garner the harvest waiting in ripeness for the sickle and the 
scythe. 

And now, coming closer to that branch of science which 
most concerns you, I must remind you that the same spirit 
which has given impetus to new thought and to new and 
enlarged conceptions of scientific research has established in 
this city a medical library greater in number and value of 
volumes than any similar library in the world, and an ana- 
tomical and pathological museum unsurpassed in the variety 
of its collections. These foundations are outgrowths of the 
war. They have been developed at such trifling expense and 
have contributed so much to the promotion and attainment 
of a higher standard of medical education that one feels mean 
at the economy which seeks to limit their expansion. 

In this connection let me say here to you, gentlemen, who 
are members of that profession whose mission will not be 
attained until the causes of disease are eradicated and death 
is limited to the ailments to which flesh is necessarily heir, 
and the processes of waste and decay, that the time has come 
when it should assert itself with all the vigor, force, and 
power which a hundred thousand men united in a common 
cause can develop and exercise. There is not one family nor 
one voter throughout tbis broad land that someone of us 
cannot reach and tell the story of parsimony which denies to 
sanitary science, protective and preventive medicine the oppor- 
tunity to accomplish the full measure of philanthropy. Nay, 
even more ; this great and munificent government educates 
its military officers, builds ships of war, adorns villages with 
costly public buildings, wastes millions on rivers and harbors, 
permits every quack, pretender, impostor, and fraud to prac- 
tise medicine who may find dupes to gull, deceive, maim, or 
kill, and seeks to strangle medical research by withholding 
the trifling pittance of a hundred journal subscriptions. With 
all this expenditure and waste of treasure there is not a poor 
boy or woman in all the land who can acquire a first-class 



310 ESSAYS AND ADDBESSES. 

medical education except by the sweat of his or her brow or 
charity of some benevolent citizen, and yet there is not oue 
man in either the national or State Legislatures, who, when 
sick and thinks the devil is at his door, waiting for his de- 
parted spirit, will fail to cry for help, relief, and time to 
make his election sure. 

In conclusion, I offer you the hospitality of our good-will, 
and beg you to believe us to be your good friends. 



THE MEDICAL SOCIETY OF THE DISTEICT OF 
COLUMBIA. 

THE MEDICAL SOCIETY OF THE DISTRICT OF COLUMBIA IN 
1894, WITH SOME IMPORTANT RECOMMENDATIONS. 
ANNUAL ADDRESS OF THE PRESIDENT, DE- 
LIVERED DECEMBER 19, 1894. 

Gentlemen : My first intention was to make this address 
a narrative of some reminiscences of my early professional 
life, that I might contrast the life and trials of the beginner 
forty-seven years ago and now ; but after its preparation I 
concluded it would be an unjustifiable departure from the 
custom of the occasion, and an unwarrantable liberty on the 
part of the chief executive officer to seek the discharge of 
such an official duty with a narration of personal reminiscences 
— especially so, in view of the historic and instructive inci- 
dents of the present year. 

The present has been an eventful year in the history of 
this Society. The commemoration of the seventy-fifth anni- 
versary, on the 16th of February last, marked an epoch which 
will be held in lasting remembrance by all who participated 
in the exercises of that brilliant occasion. 

In view of my official connection with that event and present 
relations with the Society, it becomes my duty to collate and 



ESSAYS AND ADDRESSES. 311 

record in some permanent form the more important incidents 
relating thereto and growing out of that event, which have 
made the present the most prosperous and instructive year in 
the history of this Society. 

The cordial and fraternal response of the eleven senior 
medical societies in this country to the invitation to unite 
with us in giving expression to our praise and gratitude in 
memory of the noble men who founded the Society in 1819 
was a fitting exhibition of that fraternal comity and good- 
will which make kindred of us all. 

An occasion which brings together such kindred spirits in 
homage to a common pursuit, animated by the inspiration of 
a beneficent profession, enlarges the scope of thought and 
broadens the conception of reciprocal duty. It lifts men out 
of the rut of provincial utility, widens the field of active use- 
fulness, and gives spirit and activity to the hopes of a future 
more brilliant than the past. 

If not before, we know now, that this Society, now in the 
prime of mature life, has attained that standing which places 
it among the foremost medical societies in this country. It 
has been my good-fortune, on many occasions during the 
past twenty-five years, to meet in various assemblages the 
most distinguished men of our profession in this country and 
many abroad, and I have always returned home with the 
conviction that there were members of this Society quite up 
to the highest attainments of the scientific physician. The 
more I have seen of the profession in general, the higher has 
been my estimate of the talent at home. Such is the state- 
ment of one who wishes to utter only the simple and unre- 
served truth of observation and conviction. 

During the present year thirty-five members have been 
admitted to full active membership. This fact, together 
with the largely increased average attendance (53) at the 
regular meetings, gives impetus to the progress which has 
marked the history of this Society since 1866. During the 
first session of this year the average attendance was 42 J, the 



312 ESSAYS AND ADDRESSES. 

highest number at any one meeting being SQ and the smallest 
26. During the present session the average attendance has 
been 73, the highest number at any one meeting 105, and 
the smallest 48. So that it is shown that the attendance has 
continuously increased during the year. Our distinguished 
historian, Dr. J. M. Toner, has collected ninety-four titles, 
to which a few others might be added, of contributions to 
medical and other scientific journals by members of the pro- 
fession of this District who died prior to 1866, which, he adds, 
" make a very creditable exhibit of their intelligence, high 
culture, industry, skill, and powers of observation." Those 
ninety-four essays were the contributions of thirty men ; fifty- 
seven were by seven authors, and thirty-two were the contri- 
butions of four army and two navy surgeons. The lack of 
ambition, at least so far as it might relate to the acquisition 
of a national reputation, seems to have been a characteristic 
of the earlier members of this Society, among whom were 
some very learned men. It does not appear that any one of 
them took advantage of the unusual opportunities for the 
attainment of a national reputation offered by a residence in 
a city to which came annually the most distinguished states- 
men, jurists, and politicians from every part of the country, 
and in which resided the men holding high positions in the 
national government, and the foreign embassies. It cannot 
be asserted that the reputation of any one of those learned 
and accomplished physicians extended beyond the limits of 
the " Ten Miles Square." Many circumstances may have 
induced such modesty and reticence — such as the laborious 
life of medical men during that period; the competitive 
struggle in a new and cosmopolitan city, with limited mail 
and transportation facilities; their interest and activity in 
local enterprises; the want of a leader with courage and am- 
bition to set the example and with capacity to take the lead 
in scientific medical literature ; the limited opportunities in 
the country for such publication, and none in this city — but 
the most rational explanation lies in the fact that prior to 



ESSAYS AND ADDBESSES. 313 

1866 this Society only met occasionally, at very remote in- 
tervals, for the discussion of medical and scientific subjects. 
The last clause in the preceding sentence sounds the keynote 
of progress and eminent success in every medical community. 
A practical and active working medical society is the final 
extension of the collegiate and hospital education. The later 
history of the profession in this district establishes the fact 
that, with but few exceptions, those who have attained the 
greatest success have been active and intelligent workers in 
this Society. 

Since the date (1866) at which the scientific department 
was reorganized, the number and value of such contributions 
have increased beyond the possibility of any statement, suffi- 
ciently condensed for this address, that would intelligently 
and adequately set forth their actual and relative scientific 
value. Suffice it to say that many, both in the line of ex- 
haustive discussion and original research, have been of the 
highest merit and given to their authors world-wide reputa- 
tions. Much, however, remains to be accomplished. The 
transactions of the current year give promise of a progressive 
future and the speedy attainment of that success in medical 
science which its location at the national capital demands. 

Time does not permit me to note all the papers (twenty- 
eight) and discussions worthy of honorable mention, but to 
omit reference to some of more than ordinary interest would 
be inexcusable neglect of an imperative duty. In this class 
I include the paper, with discussion, on " Diphtheria" ; the 
paper, with discussion, on " Typhoid Fever" ; and the paper 
and discussion on " Appendicitis" ; as also the report of the 
special committee, with the discussion, on " Tuberculosis," 
and the report on the water-supply and methods of filtration 
of some of the continental cities. This special notation gives 
expression with marked significance to the ability, industry, 
and patient research of those to whom credit is due, and to 
the value of the information added to the common store of 
medical knowledge. The recent papers and discussion on 



314 ESSAYS AND ADDRESSES. 

u Ear Disease " are worthy of the highest commendation. I 
regret that the report of the special committee charged with 
the investigation of the recent introduction of smallpox in 
this city could not be submitted during the present session. 
The symposium on tuberculosis was the most complete pre- 
sentation of recent knowledge of the subject that has been 
made. But the subject which has attracted the most wide- 
spread interest and attention is the report of the special com- 
mittee on the causes and prevalence of typhoid fever in the 
District of Columbia. It has disseminated more generally 
the reputation of this Society than any paper or report ever 
read before it, though in scientific value it could not exceed 
the elaborate discussions on diphtheria and tuberculosis. 

For the first time in the history of this great government 
the House of Representatives of the Congress of the United 
States has, through one of its standing committees, invited a 
medical society to appear, through a committee of its own 
members, before it to present and explain the report of its 
investigations into the causes and prevalence of typhoid fever 
in this District, and the importance and necessity for an in- 
creased and improved water-supply and sewerage-extension ; 
and, after having heard that committee, ordered, by joint 
resolutions of both Houses of Congress, four thousand copies 
of the report to be printed, and illuminated with the graphic 
illustrations which your committee had prepared to exhibit 
and demonstrate the completeness of its investigations. Never 
before in the history of this Society has the municipal gov- 
ernment sought its advice and counsel in matters of grave 
importance pertaining to sanitary science, and given promise 
of cordial co-operation in efforts to secure the enactment of 
laws to regulate the practice of medicine in the District of 
Columbia, to secure a supply of pure milk, and to prevent 
the desecration of graves. And not until recently has any 
body of its citizens requested a conference with a committee 
of this Society in the interest of the reforms referred to, 
in which the Board of Trade is equally concerned and has 



ESSAYS AND ADDRESSES. 315 

declared its purpose to promote. What is the significance of 
such facts as I have thus collated ? Do they not emphasize 
the power aud influence of this Society in this community, 
with men and bodies of men, and with the local and national 
governments ; and invite it to expand its usefulness in a 
more aggressive policy, in the line of additional and reform- 
atory legislation promotive of sanitation and preventive medi- 
cine ? I appeal to you to accept the exhortation I have so 
often delivered to you — assert yourself, that you may widen 
the sphere of your usefulness and influence. To this end I 
offered, at the semi-annual meeting in July last, the following 
amendments to the Constitution, which I commend to your 
favorable consideration: 

1. On or about the first Monday of January, annually, 
there shall be appointed by the President a Committee on 
Public Health, to consist of seven active members. 

It shall be the duty of said Committee on Public Health 
to report annually, in January, the condition of the public 
health for the preceding year. 

2. On or about the first Monday of January, annually, 
there shall be appointed by the President a Committee on 
Legislation, to be composed of seven active members. Said 
Committee on Legislation shall discharge such duties pertain- 
ing to legislation as the Society may direct. 

These two propositions are of sufficient importance to com- 
mand your attention. The third introduces a debatable issue, 
and is as follows : 

3. On or about the first Monday of January, annually, 
there shall be appointed by the President a Committee on the 
Relation of the Medical Society of the District of Columbia 
to the Public Welfare, to consist of five active members. 

It shall be the duty of this committee to consider the pro- 
priety and expediency of communications to the public either 
by the publication of reports or abstracts of the proceedings 
of the Society, and of the admission of reporters or other 
persons to the meetings on special occasions. 



316 JSSSA YS AND ADDRESSES. 

When said committee, with the consent of the Society, shall 
determine to make any communication to the public, it shall 
prepare and supervise the printing and publication of such 
communication. 

The purpose of this third proposition is to prescribe some 
definite method of communicating with the public at large, 
when, as occasion may occur, it is important or necessary 
that the general public should be advised of the consideration 
of matters that refer to the well-being and healthfulness of 
the community, and in which there is such general interest 
as makes it expedient and proper to present the consensus of 
medical opinion to the consideration of the community at 
large. Some such regulation or reform is a very desirable 
advance in the method of this Society. It will bring it in 
closer touch with public sentiment and place its membership 
upon the highest plane of good citizenship. The meetings 
of the American Medical Association and of its sections, of 
the State Medical Societies, of the Congress of American 
Physicians and Surgeons, and of the various special societies 
are open to the public without the semblance of restraint 
upon the admission of the general public. Why should this 
Society deny admission to laymen to a discussion on the 
differential diagnosis of chickenpox and smallpox, or on the 
prevention and management of tuberculosis, such as took 
place during the present year, or on the report of the com- 
mittee on the causes and prevalence of typhoid fever in the 
District of Columbia ? We cannot fill the measure of our 
responsibility, and acquire the power and influence in this 
community that belong to us, if this Society continues to 
withhold from the general public the information to which 
every good citizen is entitled. The Sanitary League and 
the Board of Trade have already grasped the opportunities 
in which this Society should have, long ago, assumed the 
leadership. 

When I came here (1848), and for many years previous, 
there was a coterie of medical men distinguished for their 



ESSAYS AND ADDRESSES. 317 

professional attainments and honored for their public spirit. 
They came to the front in every enterprise to promote the 
well-being of society, the comforts of life, and the happiness 
of the people at large. Their habits of life, general infor- 
mation, and high sense of public duty not only fitted them 
for the common duties of good citizenship, but impelled them 
to share the responsibilities and obligations in all measures 
pertaining to the Commonwealth. That such men should 
command a dominant influence in any community goes with- 
out saying. But it is not so much the fact that such was the 
case, as it is the example that should be of most value to their 
successors and survivors. The medical profession does not 
entail compulsory exemption from the ordinary public duties 
of good citizenship, and the time has come when this Society 
should assert itself with all the vigor, force, and power which 
such a body of men united in a common cause could develop 
and exercise. 

During the present year the class of " membership by in- 
vitation" has been increased by the election of thirty-five 
men coming from the medical corps of the Army, Navy, 
and Marine-Hospital Service, the three chief officers of these 
corps being included in the number. This is a full and com- 
plete restoration of the esprit de corps and comradeship which 
subsisted in the early period of the history of this Society, 
but had practically lapsed for many years past, due, perhaps, 
more to inadvertence than to intention. That you may the 
more fully realize the importance and significance of this 
restoration, let me recall your attention to the active and 
direct participation of surgeons in the Army and Navy in the 
foundation and organization of this Society and of the Medical 
Association. Thomas Henderson and Eichard Weightman, 
of the Army, and Samuel Horsley, of the Navy, were present 
at the meeting of the physicians of Washington and George- 
town, September 26, 1817, called to consider the expediency 
of the " organization of a medical society." The former was 
one of seven appointed, at that meeting, to " draft a consti- 



318 ESSAYS AND ADDRESSES. 

tution and by-laws," and at the first meeting, held after the 
adoption of the report, Weight man was elected Librarian and 
Henderson Recording Secretary, to which office the latter was 
re-elected at the first meeting (March 8, 1819), held after its 
incorporation. These incidents in the early history of this 
Society affirm the close relation and active co-operation of the 
two military corps, through their distinguished representa- 
tives, in the preliminary organization and the foundation of a 
medical society which has continuously maintained an active 
existence in commemoration of the wisdom of its founders. 
In 1820 Edmund Cutbush, of the Navy, and in 1822 Joseph 
Lovell, the first Surgeon-General of the Army, were admitted 
to membership ; and throughout the entire period of seventy- 
five years there has been a continuous succession of member- 
ship of Army and Navy surgeons. 

Strange as it may seem, it is nevertheless true that Sur- 
geon-General Lovell was the founder of the Medical Asso- 
ciation of the District of Columbia. Thomas Miller, in his 
inaugural address, delivered upon his accession to the presi- 
dency, states distinctly that the preliminary movements to 
effect the organization were suggested by General Lovell, 
and that he furnished a transcript of the rules and regula- 
tions of a similar society in Boston for the instruction and 
guidance of those associated in its establishment. Lovell 
and Henderson were members of the committee to draft " a 
system of ethics and fee bill." Lovell was elected one of the 
counsellors at the first meeting, and Henderson was the author 
of the address to the public to explain the objects and pur- 
poses of the organization, and quiet the discontent and ani- 
mosities which had incited the community to threaten acts of 
violence. 

The active influence of Lovell and Henderson in the 
organization and permanent establishment of the Medical 
Association of the District of Columbia seems to have been 
entirely forgotten. It was formed to unite the profession 
into one concrete body, upon the basis of high professional 



ESSAYS AND ADDRESSES. 319 

character and decorum, and to establish and maintain uni- 
formity of professional relation and intercourse between its 
members, thereby segregating the pretenders, charlatans, and 
men of low and doubtful repute, and, at the same time, pre- 
sent the profession to the community as a body of gentlemen, 
animated by the highest impulses of honor, dignity, and the 
obligations of Christian physicians. The wisdom of its 
organization has been attested by its history. 

The interesting and pertinent facts are that Army and 
Navy surgeons were actively instrumental in the organization 
of the two medical societies in the District, one of which has 
completed its seventy-fifth and the other its sixty-first year of 
continuous existence, and that the profession of this District 
owes to two army surgeons the inception, organization, and 
successful defence of a society, established in 1833, to define 
and prescribe the rules and regulations of ethical intercourse 
and relations of medical gentlemen, and of the profession with 
the public. Such historical events ought to guarantee per- 
manency of good-feeling and harmonious co-operation in all 
the relations of professional life and association between the 
members of these military corps on duty in this district and 
the profession, with so many of whom they may be brought 
into the closest professional intercourse. 

And now, gentlemen of the government services, in view of 
the foregoing citations of "the early and recent incidents of 
our history, I offer you the greetings of a cordial and frater- 
nal friendship, and bid you welcome to the home of your sires. 

And I offer you the congratulation of a record without one 
negative vote on the admissions of thirty-five men. 

The attempted but unsuccessful revolt of the community 
against the Medical Association of the District of Columbia 
was a most remarkable occurrence. It was a strange freak 
of public opinion that assembled citizens in mass-meetings to 
organize concerted action to frustrate the united efforts of 
physicians to enforce such rules of conduct as would secure 
to the community the full fruition of the highest qualifica- 



320 ESSAYS AND ADDRESSES. 

tions of the medical fraternity and harmonious co-operation 
among themselves in a common pursuit. And it was even 
more strange that the same citizens should in mass-meeting, 
in angry misapprehension, have resolved to sever the close 
relation of the family physician, and, to accomplish this pur- 
pose, have invited from a distance an influx of strangers to 
supply the places and accept the confidences of the evicted 
family physicians. It was not less remarkable that men so 
lacking in esprit de corps should have been so easily found 
to respond to such momentary outbursts of bad temper and 
bad manners. The sturdy independence and courage of such 
men as Lovell, Henderson, Thomas Miller, and their associ- 
ates were in marked contrast with the conduct of those who 
took fright and withdrew from the Association and of those 
who refused to join it until peace had been restored. Fortu- 
nately for the reputation of the profession, there is no record 
of the names of such recusants, beyond the statement of Mil- 
ler to the effect that " those who had withdrawn returned, 
and those who settled here under the call of the citizens peti- 
tioned for admission." 

The Health Department of this District should command 
your immediate and active attention. With the present 
management, and your earnest and effective co-operation 
with the Board of Commissioners and that body of intel- 
ligent and practical business men known as the Board of 
Trade, it may be speedily advanced to that standard of 
proficiency in sanitary science and practical work that will 
make it — what it ought to have been long ago — the most 
progressive and complete department of the kind, and an 
example to all others in this country. 

There should be established, under the immediate and 
direct supervision of this department, a biological labora- 
tory, equipped with a skilled bacteriologist, a competent 
assistant, and janitor, and supplied with all the appurte- 
nances necessary for bacteriological examination of water, 
soil, dusts, milk, and food, and also to determine the pres- 



ESSAYS AND ADDRESSES. 321 

ence and nature of specific pathogenic germs in cases of sus- 
pected contagious and infectious disease. 

Just now, when the medical world is enthused with the 
experimental success of antitoxin in the prevention and treat- 
ment of diphtheria, this capital of a great, rich, and powerful 
nation is without the means and appliances necessary for even 
an experimental observation. The good or bad effects can- 
not even be seen, much less tested and verified. This city 
should be the centre from which should emanate the infor- 
mation relating to such a discovery, and from which should 
be distributed to the millions throughout the land a remedy 
which gives promise of such untold beneficence to mankind, 
in that it may rob that most dreadful and fatal disease of its 
virulence and mortality. 

The phenomenal progress and discoveries in the past ten 
years give assuring promise of the coming triumph of medi- 
cal science, when, with the consent and intelligent co-opera- 
tion of the people, it will establish its ability to eradicate all 
preventable diseases, and then, and then only, will it have 
accomplished the highest aims of maximum beneficence. 

Xow, permit me to call your attention to some of the 
absurdities of the laws, regulations, and practices relating to 
the health and Health Department of this District. 

The chief clerk of the department is the deputy health 
officer — a combination of two systems in one occupation. If 
a health officer can only be qualified by a medical education, 
why is not such a qualification equally necessary for his 
deputy ? 

The inspection of plumbing is under the Engineer Depart- 
ment. Permits to do the work should remain as at present. 
It is not necessary that the inspector should be a physician, 
but he should be a thoroughly qualified officer and under the 
immediate direction and supervision of the Health Depart- 
ment. 

The supervision of foods and drugs and prosecutions for 
adulterations are in charge of the Commissioner of Internal 

21 



322 ESSAYS AND ADDRESSES. 

Revenue, a bureau of the United States Treasury Depart- 
ment — a glaring absurdity, fringed with red tape. 

The Health Department is charged with the work of kid- 
napping unlicensed dogs and impounding other roving beasts. 

The disinfection of private dwellings in which contagious 
diseases have occurred is intrusted to dog-catchers and cattle- 
drivers because of inadequate force and no money, with seven 
hundred thousand dollars surplus revenue in the vaults of 
the Treasury Department. The Pound Service " may be 
more honored in the breach than the observance," and the 
master and his whips may "be gashed with honorable scars," 
but the service lies too low in the lap of glory to command 
that class of intelligent employes required for the disinfection 
of private dwellings. The department should, without re- 
gard to cost, be supplied with the necessary apparatus, appli- 
ances, vans, and employes for prompt and efficient disinfec- 
tion of dwelling, furniture, and clothing. 

The medical relief of the poor, supervision of admission of 
the poor to hospitals, location and direction of free dispensa- 
ries, and control of physicians to the poor are distributed 
around and about to a variety of supervisions. They should 
be under one director, preferably the Health Department. 

Deaths without medical attendance, suspicious and crim- 
inal deaths may or may not, according to circumstances, be 
referred for investigation to either the health officer or cor- 
oner, or both. Uniformity of procedure and certainty of 
result require that one of these officers should have the 
exclusive supervision of all such classes of deaths. 

The jurisdiction of the health officer over the management 
of the public schools is limited to the abatement of nuisances 
in or about the buildings, vaccination of the scholarSj and dis- 
infection of buildings during prevalence of contagious dis- 
eases. Is it not as much 'the duty of the Commonwealth or 
municipality to make vigorous and healthy mothers and 
fathers as it is to make scholars ? 

The power, prosperity, wealth, and progress of a nation 



ESSAYS AND ADDRESSES. 323 

consist, for the most part, in the number, health, vigor, 
and intelligence of its population. Should not then the 
health officer, or some other equally competent officer, be 
charged with some definite supervision of the plans and con- 
struction of the school-buildings, and of the curriculum, that 
the physical being may not be sacrificed and dwarfed, either 
by the absence of or improper physical culture, or too much 
and too high mental development ? 

As an additional illustration of the unwise and phenomenal 
legislation of Congress, I will cite the following : 

The joint resolution legalizing the health ordinances and 
regulations enacted by the Board of Health before its aboli- 
tion, excepts, by special designation, from such legalization 
sections 7, 9, and 14 of the ordinance " to declare what shall 
be deemed nuisances injurious to health, and to provide for 
the removal thereof ;" consequently those sections are inoper- 
ative and void. 

Section 7 refers to the abatement of nuisances arising from 
stagnant water and marshy lands made " by defective drain- 
age or otherwise." 

Section 9 refers to the abatement of nuisances of " filthy 
and offensive" dwelling-houses or buildings " wherein people 
live, congregate, or assemble." 

Section 14 limits the duties of scavengers to the officers 
appointed for that purpose. 

The repeal of these provisions of the ordinance not only 
strips the Health Department of all powers to abate the nuis- 
ances referred to in sections 7 and 9, which are so common 
and detrimental to health ; but, by the repeal of section 14, 
seeks the promotion and continuous increase of defective, 
leaking, and unclean privies, by inviting every householder 
to be his own scavenger. 

With nine thousand privies in the city of Washington, 
there may be, by authority of Congress, an equal number of 
night-soil scavengers, with as many volunteer assistants, not 
one of whom would be amenable to any legal or sanitary 



324 ESSAYS AND ADDRESSES. 

regulation. Such are examples of the intelligent legislation 
for this District by the Congress of the United States. 

And now, coming nearer to our fiduciary policies, look at 
the discrimination between the two professions. The attorney 
and his two assistants receive, respectively, four, two, and 
one thousand six hundred dollars per annum. The health 
officer, medical sanitary inspector, and chemist inspector of 
dairy-products receive, respectively, three thousand, fifteen 
hundred, and twelve hundred dollars per annum. But this 
is not all. The chemist of asphalt, cement, street, and sewer 
material receives two thousand and four hundred dollars per 
annum, while the chemist of dairy-products, the food of 
babies, children, and to a greater or less extent of the entire 
population, gets but twelve hundred dollars per annum — not 
much more than enough to supply a baker's family with an 
abundance of pure, fresh milk. 

All these and many more of such incongruities of law, 
regulations, and practices are in vogue in the capital city of 
this great nation. 

The study of the morbid specimens exhibited at the weekly 
meetings, an average of 2J each week, many of which were 
of great interest, has been too superficial for such a Society 
as this. As a rule, the members are content with an objec- 
tive inspection and a description in outline of the case by the 
members in charge. I have attempted to elicit discussion, 
and occasionally indicated the points of special interest, hoping 
thereby to suggest a line of profitable debate, but without suc- 
cess. Such specimens offer the opportunity for the practical 
study of the nature and diagnosis of disease, and consti- 
tute the basis and groundwork of clinical medicine. With- 
out such knowledge the practice of medicine must be experi- 
mental and empirical. 

The exhibition of living illustrations of rare and special 
cases of disease should be encouraged. It will add greatly 
to the interest and instruction of our deliberations. 

There is a prevalent misapprehension among the younger 



ESSAYS AND ADDRESSES. 325 

members in respect to their reluctance to engage in the dis- 
cussions of scientific subjects because of the fear of criticism. 
There is no period of probation or parliamentary custom in 
this Society that imposes any restraint upon intellectual ca- 
pacity and scientific attainment. He who knows what he has 
to say can and ought to say it. The youngest member owes 
that much to himself and to his seniors. May I, in this 
connection, tell you that the first paper I read before a medi- 
cal society, now forty-two years ago, was criticised with 
unflinching severity by the late Dr. Wotherspoon, of the 
Army. I was like the poor boy at a country frolic, but I 
did not hide behind the barn-door and peep through the 
cracks to see who was in pursuit, but stormed the battery, 
coming out of it badly damaged, but alive, and have been 
myself ever since. May one, who was a doctor before the 
parents of many of you were married, and who has passed 
through the crucible of criticism, invite and lead you to the 
front rank of active and aggressive membership, for which so 
many of you are so well fitted ? 

Some method should be devised to economize the time of 
the weekly meetings. The elaborate reports prepared by the 
very efficient Recording Secretary consume a period of time 
varying from twenty to forty minutes, which should be de- 
voted to the scientific transactions. I have given this matter 
much consideration and recommend to you the creation of 
the office of Assistant Recording Secretary, with a moderate 
salary, the incumbent of which office shall be charged with 
the duty of making, after consultation with the members con- 
cerned, the necessary corrections in the reports, which shall 
be verified by a committee consisting of the President, Re- 
cording and Assistant Secretaries, and when any alteration is 
made, not accepted by said committee, such fact shall be re- 
ported to the Society at the meeting succeeding that at which 
the discussion took place. 

The policy and propriety of inviting, during each year, 
one or more men from other cities, of eminent distinction in 



326 ESSAYS AND ADDRESSES. 

special branches of medical science, to deliver addresses before 
you, are worthy of your consideration. Care should be taken 
to avoid the role of the advertising medium, and restrict such 
invitations only to physicians whose eminent success and high 
character preclude even the suspicion of motives of doubtful 
repute. If in your judgment such a departure from the or- 
dinary routine of society proceedings should be established, 
put it upon the highest plane of intellectual capacity, eminent 
success, and highest personal integrity, and then, and then 
only, will the distinguished honor find its compensation in 
the recompense of a duty well done. 

I, in common with many members, regret — in fact, I hope 
the regret is shared by every member — that the recommenda- 
tions of my immediate predecessor, in regard to the acquisition 
of a permanent home, could not be realized because of the 
legal disability of the Society to borrow or raise by assess- 
ment the necessary amount of money ; but it can receive money 
by gift, donation, and bequest to any amount that will yield 
an annual income not exceeding six thousand dollars. Then 
why not proceed as best we can to commemorate the concluding 
session of the seventy-sixth year by liberal donations to a 
home fund? Let us make one " more pull, a long pull, and 
a pull altogether," and to this end I offer you the opportu- 
nity, by distributing a circular subscription, to which you 
may affix your signatures, with the amount you may be will- 
ing to donate annually to that fund. 

The Directory for Nurses, for the most part, if not wholly, 
owes its organization and permanent establishment in this 
city to this Society. It has now become self-supporting, and 
is provided with ample accommodations for the complete 
fulfilment of all the requirements of such an institution ; but 
it lacks that general support of the profession of the District 
to which it is entitled, and to which it must appeal for that 
continued success and usefulness which have contributed so 
much to the improved management and treatment of disease. 
It has become a common practice for competent and popular 



ESSAYS AND ADDRESSES. 327 

nurses, after having qualified by registry and indorsement, 
and acquired special popularity with members of the profes- 
sion, to withdraw from the directory and organize into sepa- 
rate directories of limited members, with definite headquar- 
ters at selected localities, and then, by special and personal 
solicitations, obtain preference in selection over those to whom 
employment should be given. The members of this Society 
owe it to themselves to foster this institution to the exclusion 
of all private directories or association of nurses. I know 
this recommendation will invoke the criticism of some of the 
best and most popular nurses in this city ; but my duty to the 
sick in this community is far above my interest in the success 
of any nurse or coterie of nurses. 

With the induction of my successor into office I will have 
performed my last official act and completed the final duty 
of this last and most distinguished honor of my professional 
life. In the coming years of retirement from the places of 
honor and trust in this Society I solicit the consideration of 
one who will not be in the way of preferment and success of 
any member, and will value the regard of his associates and 
peers as the measure of his usefulness and success. In view 
of these considerations, I venture to incur the risk of unfav- 
orable criticism by making the following recommendation: 
Experience and observation have convinced me that annual 
rotation in the office of president retards the progress of scien- 
tific societies, more especially so of those that meet at short 
intervals during the greater part of each year. 

Charles Worthington, the first President, was re-elected 
for twelve successive years ; Thomas Sims died during his 
third term; Frederick May occupied the office during fifteen 
successive years ; James C. Hall declined a re-election at 
the expiration of his second term ; Alexander McWilliarns 
died before the expiration of his first year ; William Jones 
was honored by seven re-elections ; Joseph Borrows by six; 
Charles H. Lieberman by three terms ; and Thomas Miller 
by two ; and then, 1870, began the routine of annual rotation. 



328 ESSAYS AND ADDRESSES. 

During fifty-three years but nine members held the office of 
president, three of whom died in office. 

I do not advise a return to the early practice of re-election 
during life, but I do advise abandonment of the annual rota- 
tion, and the adoption of some rule of action that will more 
clearly set forth the importance and dignity of the office of 
president. 

Not one in five of the members can, to-day, name in rota- 
tion the ex-presidents now living, and it is even doubtful if 
each one of them can name the year of his service. Such are 
the inevitable results of the lamentable fact that no one, dur- 
ing the past twenty-four years, has remained in office long 
enough to impress either you or himself with the dignity and 
honor of an office that rotates the incumbent into private life 
annually on the first Monday of January. Among my prede- 
cessors there have been many who honored themselves by 
prompt and faithful discharge of the duties, but, like others. 
they stepped down and out at the expiration of one year of 
service. The record honors the man who could not find time 
to come once a week to these weekly meetings as it does the 
man who came promptly and sat here throughout the hours, 
giving his undivided attention to the duties imposed upon 
him. Do not justice and science demand discrimination 
between the unremitting discharge of honorable duties and 
loose and slipshod neglect and evasion ? My suggestion, 
then, is, when your president honors himself by faithful, 
efficient, and satisfactory services, honor yourself by a re- 
election; and then mark the continuous progress of this 
Society. 

But one death has occurred in the membership during the 
year. Dr. Charles J. Osmun died of diphtheria, contracted 
in the line of duty, thus adding another to the numerous in- 
stances of personal sacrifice and death incurred by dangerous 
exposure in the faithful and conscientious discharge of the 
obligations of our profession. The death of Osmun and of 
John W. Dunn, of the same disease, contracted in like 



ESSAYS AND ADDRESSES. 329 

manner, should admonish us of the necessity of rigid and 
thorough personal hygiene during attendance upon such cases, 
and teach the community the malignancy of a disease from 
which we, with all possible care, cannot acquire exemption. 

And now, disclaiming any invidiousness, I must commend 
to your consideration the distinguished services of your Chair- 
man of the Committee on Essays, Dr. Thomas C. Smith, to 
whose judicious and indefatigable labors I owe the debt of 
profound gratitude, in that he has crowned my administration 
of the duties of presiding officer with such success. 

The Treasurer is always in his seat guarding the treasury 
with the fidelity of one who insists upon holding a surplus 
and adding to the accumulations of the Society. 

And, finally, I beg you will accept my thanks for the honor 
conferred by election to a second term to this high office, and 
for the uniform courtesy and deference shown to me in the 
discharge of its duties. 



THE SOUTHERN SURGICAL AND GYNECO- 
LOGICAL SOCIETY. 

address of welcome to the southern surgical and 
gynecological society, delivered at wash- 
ington, november 12, 1895. 

Mr. President and Members of the Southern Sur- 
gical and Gynecological Association : Through the 
partiality of the distinguished Chairman of your Committee 
of Arrangements, I am here to offer the fraternal greetings 
of the medical profession of the District of Columbia to you 
at this first meeting of your Association north of the river 
Potomac. This invasion is the expression of that friendship 
and comity which make kindred of us all, and is significant 
only in that it is a voluntary reunion upon common territory 



330 JSSSA YS AND ADDRESSES. 

of the citizens of a common country, who are engaged in a 
common pursuit, characterized by the spirit of Christian 
benevolence and philanthropy. 

In one aspect we are your guests, invited, by your presence 
here, to participate in the consideration of the subjects set 
forth in the programme, and to co-operate with you in pro- 
moting the advancement of a science which has for its highest 
aims the amelioration of suffering and the saving and prolon- 
gation of human life. 

I need not then tell you of the pleasure it gives me to 
bid you welcome to this city of the nation, which I have 
seen grow from its village appointments to the proportions 
and grandeur of the nation's metropolis ; but I must give 
expression to the cordiality and fraternity which my juniors 
in the practice of medicine in this city have bidden me to 
offer you on this their first and only opportunity to congratu- 
late this Association on its success and achievements in the 
recent past. 

The population of this city is largely cosmopolitan, and 
more closely representative of the population of the country 
at large than that of any other city, and those of you who 
come from the tropical regions of the South, as well as those 
from the border States along the course of the historical line 
of Mason and Dixon, will find here the representative types 
of congenial manhood and responsive hospitality from every 
section of the national domain, mingling and commingling 
in one homogeneous community, irrespective of local and State 
nativities and provincial customs and characteristics, and 
engaged on equal terms in all the relations and pursuits of 
business, employment, and social life. There are, of course, 
cliques, coteries, clans, social circles, exclusive factions, gangs 
and cabals of good and evil import, but not banded by State 
and local affinities. But the truth of history compels me to 
add that its representative character would be incomplete 
without such slums as Swampoodle, Murder Bay, Hell's 
Bottom, and Hooker's Division — localities where vice and 



ESSAYS AND ADDRESSES. 331 

crime, in all their loathsome hideousness, found domicile and 
protection, but which are now rapidly disappearing before 
the energy, thrift, and progress of a cosmopolitan and law- 
abiding population. 

In a population of two hundred and seventy thousand there 
are one hundred and eighty churches ; one hundred and three 
public school buildings, with an attendance of forty-four thou- 
sand pupils ; four universities in successful operation, two 
more in course of establishment, and another in contempla- 
tion; five medical and four law schools, with annually increas- 
ing numbers of matriculates ; five general and two special 
hospitals, with accommodation for seven hundred patients; 
two foundling hospitals, one emergency hospital, and one for 
incurables, several public dispensaries, one deaf and dumb 
asylum, and one insane asylum. There are seventy well- 
established charitable and reformatory institutions, providing 
for the care of the indigent, helpless, sick, injured, and way- 
ward, of which thirty-five do not receive any public aid, but 
have been founded and are supported by the munificence of 
philanthropic citizens and residents of the Federal territory. 
There is not one gambling-house " known to the authori- 
ties," but there are five hundred and eighty licensed saloons 
— far too many in a population so abundantly supplied with 
eleemosynary, religious, and educational institutions, which 
in some measure is due to inadequate legislation by Congress. 
Thus, notwithstanding our dependence upon a legislature 
without representation, the citizens and private property- 
holders of the Federal territory exhibit most remarkable 
and creditable progress in all those qualities and instrumen- 
talities of enlightened and Christian civilization which con- 
tribute so much to the well-being of the human race and have 
made this the foremost nation on the globe. 

You must excuse the interpolation, in this connection, of 
the statement that in this District the death-rate has gradually 
diminished in the past fifteen years, and the average longevity 
of decedents has increased. Among the whites four years 



332 ESSAYS AND ADDRESSES. 

nine months and nineteen days, having risen from thirty-two 
years and three days in 1881 to thirty-six years nine months 
and nineteen days in 1895; and among the colored from 
twenty years ten months and eleven days in 1881 to twenty- 
five years eight months and twenty-seven days in 1895. 
These figures exemplify the maxim of Professor Pierce, that 
"virtue, like intellect, doubtless tends to longevity. " If 
time permitted, I might, with equal precision, show that this 
population is characterized by three elements of strength of a 
people — " longevity, fecundity, and vigor." 

In another aspect you are guests, and, in behalf of the pro- 
fession and of the community at large, I welcome you to the 
only city in this great and populous country wherein each 
one of you can claim and enjoy the privileges and immunities 
vested in common citizenship, insomuch as each one and all 
of you, in some measure, hold, in common with the many 
millions of citizens, proprietary rights and sovereign power. 
That you may fully estimate and appreciate the magnitude of 
such prerogatives, let me tell you that in the area of 69,245 
square miles covering the territory of the District of Colum- 
bia the Government owns four thousand two hundred and 
twenty acres of land, exclusive of the streets, avenues, and 
alleys of the city, and property in this city valued at $201,- 
711,959, being $10,294,155 in excess of the value of private 
property. To this valuation must be added the value of the 
Government lands lying outside of the limits of the city, 
which comprise three thousand four hundred and twenty 
acres, which, with the improvements thereon, are estimated 
at the low valuation of eight and one-half millions of dollars. 
The aggregate of the Government realty in the District of 
Columbia, including the streets, avenues, and alleys of the 
city, but not including the enormous tract of reclaimed Poto- 
mac River flats or purchases since 1889, is seven thousand 
eight hundred and twenty-six acres of land. 

And now, if you will go with me through these streets and 
avenues, you will see these properties represented in magnifi- 



ESSAYS AND ADBBESSES. 333 

cent public buildings, decorated and improved parks and 
reservations. But this great Government has not limited its 
possessions and expenditures in this District to the acquisition 
of realty, the construction of public buildings and improve- 
ment of parks, but has been a generous though inadequate 
contributor to the development and advancement of various 
branches of science, in the establishment and support of 
bureaus and departments of science, art, and literature, com- . 
prising Architecture, Astronomy, Astro-physics, Animal In- 
dustry, including infectious diseases and pathology of animals, 
dairy investigations, and zoological and biochemic laboratories; 
Agrostology, Biology, Botany, Bibliography, Climatology, 
Forestry, Education, Entomology, Ethnology, Hydro- 
graphy, Hydrometry, Hygiene, Ichthyology, International 
Exchanges, Meteorology, Mammalogy, Metallurgy, Museum, 
Law, Medicine, Printing and Engraving, Ornithology, Ord- 
nance, Vegetable Pathology and Physiology, Pomology, Soils 
and Foods, Weights and Measures, Quarantine, Bacteriology, 
Pathology, Statistics, and Zoology. 

I cannot detain you with a statement in detail of the opera- 
tions of these scientific foundations, not as yet complete in any 
department, but steadily progressing toward that standard of 
excellence and usefulness which will, in the near future, make 
the political home of the nation the centre of science, litera- 
ture, and art. But I can assert that in learned and scientific 
institutions, bureaus, departments, and great national libra- 
ries, with their corps of experts in the various branches of 
science, this city offers opportunities not excelled in any city 
in this country. 

And now, coming closer to that branch of science which 
most concerns you, I must remind you that the same spirit 
which has given impetus to new thought and to new and en- 
larged conceptions of scientific research has established in this 
city a medical library greater in number and value of volumes 
than any similar library in the world, and an anatomical and 
pathological museum unsurpassed in the variety of its collec- 



334 ESSAYS AND ADDRESSES. 

tions. The publication of the Index Catalogue in connection 
with this magnificent library will contribute more toward the 
higher education of the medical profession than any single act 
of any nation on the face of the globe. Then, too, the Gov- 
ernment has established a Museum of Hygiene and a National 
Quarantine, both important adjuncts of preventive medicine, 
which will continue to grow in usefulness to the Government 
and to the people-at-large. 

These foundations have been developed under the fostering 
care of a munificent Government. It may be that it needed 
these establishments to fulfil its delegated functions, and is 
compelled to secure the services of skilled medical men (to 
superintend their proper administration) ; nevertheless, even 
admitting this necessity to be the primary cause for their foun- 
dation, it in no manner impairs their value to the profession, 
and the duty is imposed upon us to utilize them for the com- 
mon good and to widen the scope of such endowments to the 
end that we and the people may realize the full measure of 
their usefulness. 

I solicit your aid and co-operation in our effort to secure 
the protection of our people from the horde of impostors and 
charlatans which you have driven from your borders by the 
enactment and enforcement of medical practice laws, and 
which has made the District of Columbia a common rendez- 
vous where the most atrocious methods of the charlatan and 
mercenary impositions are openly and flagrantly committed 
to the wrong, injury, and robbery of its citizens. You repre- 
sent the most influential and intelligent class of suffragists, 
for whose aid on the hustings and at the polls we plead. 

To state the deplorable condition of this District fully and 
broadly, there are five medical schools and several medical 
societies chartered by Acts of Congress, or under the general 
incorporation law, authorized and empowered to license per- 
sons to practise the art and science of medicine, without any 
uniform, and by some without any standard of qualification 
beyond the ability and willingness of the applicant to pay the 



ESSAYS AND ADDBESSES. 335 

required fees or give promissory notes for such payment; 
and under the provisions of the general incorporation law 
any dozen of persons can obtain a charter, upon payment of 
the fee for recording the same, authorizing them as a body 
corporate to confer the degree of M. D. at their pleasure and 
will. Such is the status of this Federal territory, which is 
under the exclusive jurisdiction of the highest tribunal of 
legislation in the land, made up of the Representatives and 
Senators, from forty-one States and Territories, which have 
enacted medical practice laws for the protection and welfare 
of their citizens. Take these facts home with you and re-echo 
them throughout the length and breadth of the land, that 
such criminal neglect, not less disgraceful and scandalous than 
the slums of vice, may not continue to afflict the citizens of 
the Federal territory. 

Pardon, in conclusion, the invocation of one who has nearly 
completed a half-century of service in the practice of medi- 
cine, to assert the highest prerogatives of the science of medi- 
cine, and by unity of effort enforce them in the interest of 
and for the welfare of mankind, in that governors, legislative 
bodies, town councils, and all others in authority may come 
to know in the near future that in preventive and remedial 
medicine truth and science must dominate whim, caprice, 
charlatanry, and mercenary adventure. 



THE MEDICAL SOCIETY OF THE DISTRICT OF 
COLUMBIA. 

ANNUAL ADDRESS OF THE PRESIDENT OF THE MEDICAL 

SOCIETY OF THE DISTRICT OF COLUMBIA, 

DELIVERED DECEMBER 18, 1895. 

Gentlemen: It gives me great pleasure to congratulate 
the Society upon its continued prosperity and activity. Dur- 
ing the year forty additional members have been admitted to 



336 ESSAYS AND ADDBESSES. 

the active list and twenty-two to the membership by invita- 
tion. Every meeting has been abundantly supplied with 
material for consideration and discussion. In fact, at times 
the offers have been so numerous that the authors were re- 
quired to abbreviate their essays to a prescribed limit of time. 
The discussions have been full and interesting, and, with rare 
exceptions, closely applied to the subject under consideration, 
with much less irrelevancy than is usual in impromptu dis- 
cussions. The debates have shown also a marked and com- 
mendable improvement in fluency of speech and conciseness 
and correctness of diction. 

In consequence of my long absence from the weekly meet- 
ings during the later months of the first session, I am not 
permitted to make any analysis of the scientific merits of the 
papers read, or even to cite those of special merit; but I 
cannot omit honorable mention of the addresses of Drs. 
W. P. Mason, of Troy; A. H. Smith, of New York; 
William Osier, of Baltimore ; and Abraham Jacobi, of New 
York. 

Notwithstanding the falling off of the weekly attendance 
during the later months of the first session of this year, the 
average attendance was sixty-three, being an average increase 
of twenty-two more than for the corresponding period of 
1894. During the present session the largest number present 
at any one meeting was 111, and the average has been 94, 
thus showing a largely increased attendance during the pres- 
ent year. These figures exhibit a most commendable interest 
in the transactions of the Society. It is hoped the impetus 
which the Society has acquired in the past two years will con- 
tinue with unabated force, and that the transactions of suc- 
ceeding years may be enriched with the evidence of that 
progress which will, in the future, as in the past, continue 
to elevate the science of medicine and widen the scope of its 
beneficence. 

Sufficient time has not yet elapsed to establish the wisdom 
and utility of all the recommendations made in the last annual 



ESSAYS AXD ADDRESSES. 337 

address, and which were adopted by the Society. There is 
no dissentient suggestion of an unfavorable result of their 
diligent and impartial enforcement. 

I am not without hope that the Society may recede from 
its dissent to the recommendation that its scope of power and 
usefulness would be extended and enlarged by some method 
of communicating to the public the matters that refer to the 
well-being and healthfulness of the community, and in which 
there is such general interest as makes it expedient and proper 
to present the consensus of medical opinion to the considera- 
tion of this community. Perhaps the expediency and pro- 
priety of such an innovation could be more satisfactorily 
determined by the tentative approach to such policy under 
the operation of some temporary regulation than by a consti- 
tutional provision. 

The propriety of inviting, during each year, one or more 
men from other cities to deliver addresses before you has 
proved eminently successful and instructive; but I must 
renew the admonition to avoid the role of the advertising 
medium, and restrict such invitations to physicians whose 
eminent success and high character preclude even the sugges- 
tion of motives of doubtful repute, and to condemn by posi- 
tive refusal all personal solicitations. 

Milk Legislation. 

The efforts of the Committee on Legislation to secure the 
enactment of a law to regulate the supply and sale of milk in 
this District have not been entirely satisfactory. The bill, 
H. of R. No. 8231, which had received the indorsement of 
the Commissioners of the District and of this Society, passed 
the House of Representatives without alteration, but the Sen- 
ate Committee on the District of Columbia suggested so many 
amendments, which so completely eliminated its penal provi- 
sions, that I presented to the Senate the following remon- 
strance to their adoption : 

22 



338 ESSAYS AND ADDRESSES. 



53d Congress, \ SENATE. $ Mis. Doc. 

Zd Session. J ( No. 96. 



IN THE SENATE OF THE UNITED STATES. 

February 8, 1895. — Laid on the table and ordered to be 
printed. 

February 15, 1895. — Ordered to be reprinted, with 
appendix. 

Mr. Faulkner presented the following memorial, from the 
Medical Society of the District of Columbia, favoring the 
passage of H. R. 8231, entitled "An Act to regulate the sale 
of milk in the District of Columbia," and appendix. 

To the honorable Senate of the United States in Congress 
assembled : 

The Medical Society of the District of Columbia respect- 
fully represents to the honorable Senate that the bill of the 
House of Representatives, No. 8231, entitled " An Act to 
regulate the sale of milk in the District of Columbia, and for 
other purposes/' now pending before the honorable Senate, 
originated with the Commissioners of the District of Colum- 
bia, and was submitted by said Commissioners to this Society 
for examination and approval. After a thorough considera- 
tion this Society gave to the bill, as it has been passed by the 
House of Representatives, its unanimous and unqualified in- 
dorsement. Subsequently the same bill was approved by the 
legal adviser of the Commissiouers and by Dr. D. E. Salmon, 
Chief of the Bureau of Animal Industry of the Department 
of Agriculture. 

The Medical Society of the District of Columbia respect- 
fully represents to the honorable Senate that the purpose of 
the bill, as passed by the House of Representatives, is to 
secure to the residents of this District a supply of good, un- 
polluted, and unadulterated milk, which cannot be secured 
except through the enactment and enforcement of a law that 



ESSA YS AND ADDRESSES. 339 

will compel the milk producers and dealers to supply the food 
at a fisted standard of quality, purity, and freedom from the 
germs of disease. 

The consensus of medical opinion establishes the fact that 
the present method of production, collection, and supply of 
milk in this District is one of the most dangerous of human 
industries in that the supply is subjected to contamination 
with the germs of disease from infected milk-yielding animals 
and from persons employed about the dairy-farms. It is 
known that milk from tuberculous cows will convey tuber- 
culosis, the most dreadful and fatal of all diseases in this 
country, to human beings, and more especially to young chil- 
dren fed upon such infected milk. 

It is, however, not only disease in the cow which may be 
conveyed. It often conveys virulent, infectious diseases from 
the dairyman's family to his customers. Typhoid fever, scar- 
let fever, and diphtheria have been very frequently conveyed 
by the transmission of the germs of these diseases from the 
farm to the consumers of the milk. By reference to the 
appendix it may be seen that 138 epidemics of typhoid 
fever, 74 of scarlet fever, and 28 of diphtheria have been 
positively traced to milk infected with the germs of these 
diseases. 

Milk is such an admirable medium favorable to the growth 
of bacteria that even when taken from cattle entirely healthy, 
and on farms free from- infectious and contagious diseases, it 
will, unless properly prepared for transportation, undergo 
such rapid changes, induced by bacteria, that it may be ren- 
dered unfit for human food, especially for young children, 
before it can be delivered to the consumers. 

In view of the foregoing facts it becomes an absolute 
necessity, in the interest of sanitary science and preventive 
medicine, that the sale of milk in this District should be 
regulated by such legislation as will afford that protection 
from preventable causes of disease which the welfare of the 
community demands. 



340 ESSAYS AND ADDRESSES. 

■ 

The proper inspection of milk requires a chemical and 
bacteriological examination by persons skilled in such exam- 
inations of dairy-products. To such investigations must be 
added personal inspection, at intervals not to be fixed or 
known to the dairymen of the herds and farms, that unfit 
and improper feeding and housing may be detected. The 
freedom of the herd from tuberculosis can be positively and 
only determined by the tuberculin-test. So also is a personal 
inspection of the farm necessary to prevent the infection of 
the milk by the germs of diseases, such as typhoid fever, 
scarlet fever, and diphtheria, with which some of the em- 
ployes may be afflicted. 

The Medical Society of the District of Columbia fears that 
the proposed amendments to House bill No. 8231 are exclu- 
sively in the interest of milk producers and dealers, and, if 
adopted, will promote and protect more aggressive frauds 
than have heretofore been perpetrated upon the consumers 
of milk in this District, by more frequent and deliberate 
adulterations and pollution of the milk supplied to them. 
This apprehension grows out of the fact that in every section 
of the bill defining an offence its violation is qualified by the 
proposed insertion of the words " knowledge, known, or 
knowingly/' which it is believed will render those provisions 
of the bill inoperative. In the case of The People v. Kebler, 
New York Court of Appeals, the Court said: 

" Experience has taught the lesson that repressive measures 
which depend for their efficiency upon proof of the dealer's 
knowledge, and of his intent to deceive and defraud, are of 
little use aud rarely accomplish their purpose. " 

The Society begs leave, furthermore, to suggest that the 
bill, with the pending amendments, will so increase the 
profits of disreputable producers and dealers that those 
wishing to supply good and unpolluted milk will be driven 
from the trade, and that the supply of unadulterated and 
infected milk will be increased, to the detriment of the con- 
sumers, and the Society therefore prays that the honorable 



ESSAYS AND ADDBESSES. 341 

Senate will concur in the enactment of House bill No. 
8231. 

I have the honor to be your obedient servant, 

Samuel C. Busey, M.D., 

President of the Medical Society of the District of Columbia. 

At a subsequent hearing before the subcommittee, com- 
posed of Senators Faulkner, Hunton, and Gallinger, the 
committee was induced to recede from some and to modify 
others of the proposed amendments, so that, finally, the bill 
was passed as the law now exists. This law is a step far in 
advance of the previous regulations of the supply and sale of 
milk, but falls short, in many particulars, in securing to the 
consumers of milk in this District a supply free from adul- 
teration and pollution. 

At this hearing it was strangely apparent that legislators 
of such high distiuction and intellectual attainments should 
be so reluctant to accept the clinical evidence of milk-infec- 
tion with germs of contagious diseases, and refuse the full 
measure of protection which this community demands. In a 
recent paper read before this Society the filthy contamination 
of the milk-supply of this city was so fully set forth that no 
one could doubt its disease-producing qualities. 

Report of Zymotic Diseases. 

The experience of the present year has clearly demonstrated 
the necessity of some compulsory legislation requiring every 
physician to report to the Health Department every case of 
zymotic disease occurring in his practice. No system of 
sanitation or preventive medicine can be effective without the 
knowledge of the number and location of every such case of 
disease, at all times of the year, and more especially during 
the prevalence of an epidemic. If every case of typhoid fever 
that has occurred in this District during the present year 
had been promptly reported to the Health Department, the 
fair fame and healthfulness of this citv would not have been 



342 ESSAYS AND ADDRESSES. 

tarnished by the exaggerated and detrimental reports which 
have been spread all over the country, and the cases due to 
milk- and water-infection and soil-pollution could have been 
classified with almost absolute accuracy. There would have 
been fewer cases and a lower death-rate. The constantly reiter- 
ated statement that this or that family or " my people " would 
not permit such reports is a fallacy unworthy of respectful con- 
sideration, when the mortuary columns of the local press are 
teeming with reports of distress and sorrow that bring home 
to every household the inadequacy of municipal protection 
from preventable diseases. Every good citizen will willingly 
submit to a law that offers protection from sorrow, suffering, 
expense, deaths, and funerals. 

Jfedical Practice Laic. 

The history of the efforts, disappointments, and failures of 
this Society to secure the enactment of a law to regulate the 
practice of medicine in this District has not been written. It 
therefore becomes my duty, as the chairman of the committee 
now in charge of legislation, to record in some permanent 
form the proceedings of this committee. In 1893, some time 
previous (15 months) to the appointment of the present com- 
mittee, the first effort was made, which culminated in the 
enactment of a law, entitled " An Act to incorporate the 
Eclectic Medical Society of the District of Columbia," which 
endowed seven persons, therein named, not one of whom was 
a member either of this Society or of the Medical Association 
of the District of Columbia, " with all the rights, privileges, 
and immunities that appertain to other medical societies in 
the District of Columbia." This statute confers upon that 
Society the corporate power to license persons to practise 
medicine in this District. 

In 1870 Congress passed "An Act to incorporate the Wash- 
ington Homoeopathic Medical Society, " in which it is provided 
that said Society shall examine and " license to practise medi- 
cine or surgery in the District of Columbia " only such can- 



ESSAYS AND ADDRESSES. 343 

didates as shall u sustain a good moral character, and shall 
present letters testimonial of their qualifications from some 
legally authorized medical institution." In abstract, this is 
a more specific definition of the qualifications of the licentiate 
than is set forth in the charter of this Society, granted in 
1819, which prescribes that it shall elect a board of exam- 
iners, " whose duty it shall be to grant licenses to such medical 
and chirurgical gentlemen as they may, upon full examina- 
tion, judge adequate to commence the practice of the medical 
and chirurgical arts, or as may produce diplomas from some 
respectable college or society." The charter of the Medical 
Society of the District of Columbia, therefore, ordains the 
alternative of an examination of or the presentation of a 
diploma by its licentiates, which was eliminated from the 
charter of the Washington Homoeopathic Medical Society. 

Twenty-three years after the date of the charter of the 
Washington Homoeopathic Medical Society, 1893, the Con- 
gress of the United States chartered a third medical society, 
" endowed with all the rights, privileges, and immunities" 
of the two senior medical societies, and empowered it " from 
time to time to make such by-laws, rules, and regulations as 
they find necessary, and do and perform such other things 
as may be requisite for carrying this Act into effect, and 
which may not be repugnant to the Constitution and laws of 
the United States." The endowment of a medical society 
with such extraordinary powers and rights constitutes a retro- 
grade movement in medical education, and may establish such 
an obstacle to the attainment of the higher standard of knowl- 
edge in medicine as to invoke remonstrance, pushed to the 
limit of resistance. A liberal and perhaps fair interpretation 
of the provisions of this Act might possibly confer the cor- 
porate power to supply this community with u physicians, 
not less in number than its population, without licenses or 
diplomas from responsible, respectable, or other legally au- 
thorized medical college, society, or institution, and inde- 



344 ESSA YS AND ADDRESSES. 

pendently of the annual influx of the quacks, charlatans, and 
impostors driven hither from the States and Territories. 

Notwithstanding these failures and disappointments, this 
Society accepted the invitation of the Washington Homoeo- 
pathic Medical Society to unite in the preparation of a bill 
that would be satisfactory to both. The joint committee failed 
to agree, and this Society completed the preparation of the 
bill that was introduced into Congress July 7, 1894, and is 
known as House bill No. 7661, entitled " A bill to regulate 
the practice of medicine and surgery in the District of Colum- 
bia and for other purposes." This bill was referred " to the 
Committee on the District of Columbia and ordered to be 
printed/' and there it remained without farther consideration. 

In October following (1894) this Society reorganized its 
Committee on Legislation, which proceeded immediately to 
discharge the duties imposed upon it. Upon its recommen- 
dation the Society amended House bill No. 7661 by elimi- 
nating from its provisions every reference to the Homoeopathic 
and Eclectic Medical Societies. These emendations grew out 
of the failure of the conferences of the previous committee of 
this and the Homoeopathic Society to agree in framing a bill 
satisfactory to the latter society, and it was therefore deemed 
most expedient by the committee, then in charge, for this 
Society to present its views in a distinctly concrete form, 
absolutely free from any proposition of compromise with any 
and all other medical societies, and thereby compel the dis- 
senting societies to commit themselves to definite views and 
propositions, as the basis of an amicable adjustment of differ- 
ences by the legislative authority. As thus amended it was 
presented, December 10, 1894, by the Hon. J. T. Heard, 
and is known as House bill No. 8133. 

Subsequently, December 17, 1894, the Hon. H. W. Blair 
offered a bill to regulate the practice of medicine in the Dis- 
trict of Columbia, known as House bill No, 8229, which was 
intended to enact " that the Physio-Medical School of Medi- 
cine shall have all the rights, privileges, and protection that 



ESSAYS AND ADDRESSES. 345 

is or may be provided by law for allopathic, homoeopathic, 
or any school of medicine within the District of Columbia." 

After a preliminary hearing of the H. of R. Committee 
on the District of Columbia, at which bill No. 8133 was 
fully explained and the object of this Society in seeking its 
enactment was fully set forth, it was referred to the Com- 
missioners of the District of Columbia for consideration 
and recommendation. As is customary, the Commissioners 
granted, December 19, 1894, a special hearing to those 
interested in the bill, at which there were present committees 
representing this, the Washington Homoeopathic and Eclectic 
Medical Societies, and several other persons. At this con- 
ference a most pronounced opposition to bill No. 8133 was 
developed and urged with considerable force and pertinacity; 
some objecting to any legislation on the subject, and others to 
the exclusive provisions of the bill. The Washington Homoeo- 
pathic Medical Society offered a substitute, identical in some 
of its sections with House bill No. 8133, but differing in the 
method of establishing and enforcing a uniform standard of 
qualification. Its committee not only conceded the necessity 
of a law to regulate the practice of medicine in this District, 
but based its action upon the broad statement that the laws 
of this District " were totally inadequate to protect its citizens 
from imposition." 

This substitute bill was subsequently, January 23, 1895, 
introduced into the Senate, and is known as Senate bill No. 
2645, and was referred to the Commissioners, by whom a 
second special hearing was granted, which was in effect a 
recapitulation of what occurred on December 19, 1894. At 
this stage of the proceedings the whole question remained in 
abeyance until the report of the Commissioners was made in 
the form of a bill introduced into the Senate by Senator Har- 
ris, January 31, 1895, and known as "the Commissioners' 
bill" or Senate bill No. 2685 (53d Congress, 3d session). 
The bill was modelled after the laws of New York and Penn- 
sylvania, and would have been accepted by the committee of 



346 ESSAYS AND ADDBESSES. 

this Society but for several interpolations, more especially the 
following: 

" Any applicant intending to practise in the District of 
Columbia any system of medicine or treatment other than 
the regular or homoeopathic or eclectic system, and stating 
such intention in his application, shall be exempt from such 
part of any examinations to which he may be subjected as 
relates exclusively to the treatment of disease, but such appli- 
cant shall submit in all other branches to the same examina- 
tions as are required of other applicants, and shall be exam- 
ined by such boards of examiners as may be designated by 
the board of medical supervisors: Provided, That any per- 
son who may avail himself of the exemption allowed by this 
clause, and who receives a license under this Act, shall cause 
at all times to be plainly affixed to any sign or signs he may 
erect or cause to be erected, and to any prescription-blanks, 
bill-heads, and other articles he may use in his professional 
work, and to be inscribed in any advertisement he may cause 
to be displayed, the designation of the system of medicine or 
treatment employed by him for the cure or relief of disease." 

To this bill your committee addressed the following protest 
to the Commissioners, to which no reply has been made: 

"1545 I ST., N.W., 
" Washington City, February, 1895. 

u Hon. Commissioners of the District of Columbia: 

" Gentlemex: I am instructed by the Committee on 
Legislation of the Medical Society of the District of Colum- 
bia to communicate to your honorable board the objections 
of said committee to several provisions of the bill known as 
the ' Commissioners' bill/ and entitled 'A bill to regulate 
the practice of medicine and surgery, to license physicians 
and surgeons, and to punish persons violating the provisions 
thereof in the District of Columbia.' 

" The committee of the Medical Society suggests that sec- 
tion 1 be so amended that not more than two of the board of 



ESS A YS AND ADDRESSES. 347 

medical supervisors shall be appointed from either of the 
three systems of medicine recognized in the bill, so that it 
will be impossible for either of these systems of medicine to 
acquire a majority of said board of medical supervisors. 

" The committee recommends the omission of all of section 
2 after the word ' surgery/ in line 30. This clause provides 
for the licensing of any applicant intending to practise in the 
District of Columbia any system of medicine or treatment 
other than the regular or homoeopathic or eclectic system, 
and is objectionable not only because it is an invitation to 
the horde of charlatans, pretenders, and impostors driven 
from the States by the enforcement of medical practice laws 
which prevent the prosecution of their nefarious and merce- 
nary impositions to settle in this District, now the common 
rendezvous of such disreputable classes, but it is a direct and 
positive insult to every intelligent and educated physician in 
that it ignores all and every method and system of prelimi- 
nary and technical education, and is indirect conflict with the 
reforms and elevated standard of medical education which 
the profession is putting in active operation throughout the 
country. There is now in this city one system, claiming to 
have a charter obtained under the provisions of the general 
incorporation law, with one emeritus professor and one gradu- 
ate, who signed the certificate of his own graduation. Under 
the clause referred to, unlike systems but similar institutions 
may be chartered at the will of any drug or medicine fiend, 
and be entitled to a license to practise the science of medicine 
in this District. 

" The same clause of section 3, lines 45 to 47, compels 
such applicant, when licensed, to insert ' in any advertise- 
ment he may cause to be displayed the designation of the 
system of medicine or treatment employed by him for the 
cure and relief of disease. 5 Thus not only is the fraud to 
be licensed, but, when licensed, he is required to commit a 
fraud upon the credulous public by advertising to do that 
which he knows he cannot do. 



348 ESSAYS AND ADDRESSES. 

" The third objection to the ' Commissioners' bill ' refers 
to the omission of any provision prohibiting ' publicly adver- 
tising ability to treat and cure diseases/ as is usual in medical 
practice laws. Such a prohibition would banish from this 
District every such disreputable pretender and protect this 
community from that class of frauds and impostors driven 
from the States and Territories. It is idle to claim that such 
result can be accomplished by the enforcement of the rules, 
regulations, and codes of medical ethics, when only such per- 
sons can be made amenable to such rules and codes as may 
have acquired membership in ethical organizations. The 
advertising charlatan has no code but that of fraud and 
criminal deception. 

" The Medical Society of the District of Columbia is will- 
ing to accept any one of the forty-one medical practice laws 
now in force in the States and Territories of the country, 
except the Alabama law, to which it objects because of a pro- 
vision somewhat similar to the objectionable clause in section 
3 of the i Commissioners' bill/ but which is more securely 
guarded, because of the supervision of the State Medical 
Society. 

" The committee, therefore, requests the Board of Com- 
missioners so to modify the bill S. 2685, known as the 
' Commissioners' bill/ that it may give to it its unqualified 
support. 

" I have the honor to be, 

u Your obedient servant, 

" Samuel C. Busey, M.D., 

"Chairman of Committee of the 
" Medical Society of the District of Columbia." 

At a second hearing by the House Committee on the Dis- 
trict of Columbia, at which were considered the Commissioners' 
bill and the substitute bill (S. 2645) of the Homoeopathic 
Medical Society, there were present representatives of the 
three chartered medical societies, the Physio-Medical School, 
White Cross University of Science, and the Vivopathic 



ESSAYS AND ADDRESSES. 349 

System, and some individuals with grievances in general. 
The Physio-Medical School set forth with loud and vehement 
clamor its super-excellent and even transcendent powers and 
attributes that would " eventually conquer the world of medi- 
cal science," and asserted with convulsive triumph that its 
devotees " did not carry their diplomas on paper, but in 
their heads." The White Cross University and Vivopathic 
System was opposed to any proposition to " establish a medi- 
cal monopoly," because it u did not need much teaching/' 
citing in proof thereof the fact that " the university had 
granted but one diploma," and that " to one who came with 
a diploma from the eclectic school." Altogether, this dis- 
cussion proved more entertaining than instructive, but was, 
nevertheless, convincing of the necessity of additional legis- 
lation. 

In consequence of the opposition to the Commissioners' 
bill, which no one would accept as a whole, and was only 
accepted in part by your committee, the Homoeopathic sub- 
stitute bill assumed greater importance as the basis of adjust- 
ment of the differences between that and this Society, and 
would probably have been adopted by the House Committee 
but for the opposition of your committee to several of its 
provisions. The committee in charge of it made sundry im- 
portant concessions, and manifested such spirit of conciliation 
that an agreement seemed to be within actual possession. 
Your committee, however, after more deliberate considera- 
tion, directed the following communication to be sent to the 
Committee of the Homoeopathic Medical Society : 

"1545 I St., N. W., 
" Washington, D. C, February 7, 1895. 

' ' Dear Dr. Custis : I am directed by the committee of 
the Medical Society of the District of Columbia to inform you 
that it cannot accept your bill, even with the amendments 
which you propose. The main objections to the bill are: 

''First. It does not establish a uniform standard of quali- 
fication. 



350 ESSAYS AND ADDRESSES. 

11 Second. There is no or inadequate supervision of the acts 
of the separate examining boards. 

u Third. That any two of the examining committee can 
license any applicant, however deficient his qualifications 
may be. 

" I am instructed, furthermore, to inform you that the 
committee will urge the Commissioners' bill, but will seek to 
amend it by striking out the clause inviting other and new 
systems to apply for license; by inserting a provision against 
the advertising charlatan ; and, lastly, by limiting the ap- 
pointment of the Board of Supervisors so that not more than 
two can be of the same school of medicine. 
" I have the honor to be 

" Your obedient servant, 

"Samuel C. Busey, M.D., 

" Chairman of Committee of the Medical Society 
" of the District of Columbia." 

This communication concluded the conferences and corre- 
spondence. Three days later I was directed to address the 
following communication to the Senate Committee on the 
District of Columbia : 

"1545 1 St., N. W., 
" Washington, D. C, February 10, 1895. 

" Senator Isham G. Harris, 

" Chairman Committee of District of Columbia. 

"Dear Sir: I am instructed by the committee of the 
Medical Society of the District of Columbia to inform the 
Committee of the Senate on the District of Columbia that it 
is opposed to the passage of any of the bills now pending to 
regulate the practice of medicine in the District of Columbia, 
because of their failure to secure a uniform standard of medi- 
cal education, and to prevent discrimination in favor of or 
against individuals. 

"I am instructed also to state that the Medical Society 
of the District of Columbia is willing to accept any of the 
medical practice laws in operation in the States and Territo- 
ries except that of the State of Alabama. 



ESSAYS AND ADDRESSES. 351 

" The committee begs that the Senate Committee will grant 
it an opportunity to be heard before it concludes its considera- 
tion of the subject. 

" I have the honor to be 

i ' Your obedient servant, 

" Samuel C. Busey, M.D., 

" Chairman of Committee of the Medical Society 
"of the District of Columbia." 

A few days later I was verbally informed that the Senate 
Committee had, for waut of time, declined to consider the 
subject during the session. 

The foregoing history points to the following conclusions : 

1. No bill containing the clause in the Commissioners' bill 
relating to other and new systems will be satisfactory either 
to this or the Homoeopathic Medical Society, and cannot be- 
come a law without their concurrence. 

2. No bill can become a law that is not satisfactory to both 
of these medical societies. 

3. No bill can become a law without the assent and sup- 
port of the Homoeopathic Medical Society. 

4. No law will be adequate or effective that does not annul 
the extraordinary powers and privileges granted the Eclectic 
Medical Society. 

5. Constant vigilance on the part of this Society may be 
imperative to prevent the passage of some law relating to the 
practice of medicine in the District of Columbia more objec- 
tionable than the charter of the Eclectic Medical Society. 

With these facts and conclusions before you, what course 
will this Society pursue ? Will you abandon the issue and 
leave the field of your labors to charlatanry, imposition, and 
fraud, or will you follow the example set by the medical fra- 
ternity in forty-one States and Territories ? You made the 
issue, and every consideration of duty to yourselves and to 
this community commands its prosecution to a final and sat- 
isfactory conclusion. Seventy-seven years ago twenty-one 



352 ESSAYS AND ADDRESSES. 

qualified physicians, animated by the courage of their con- 
victions and the obligations of imperative duty, united in an 
organization to protect the citizens of the District of Columbia 
from the wrongs and injuries perpetrated by the horde of 
charlatans and pretenders that had flocked here like vultures 
to prey upon the innocent and credulous sick and suffering. 
Now that the evils and atrocities have been multiplied to the 
utmost limit of wrong, injury, and crime, will you, with an 
organization far greater in number and power, do less ? In 
forty-one States and Territories public opinion, the welfare of 
society, and unanimity of medical opinion have compelled the 
Legislatures to guarantee by statute law the protection which, 
because of such protective legislation, is all the more needed 
by this community, that the perpetration of such wrongs and 
injuries may at least be limited to such agencies and instru- 
mentalities as may have acquired vested rights in ignorance, 
deception, and fraud. 

There are in this District five medical schools and several 
medical societies chartered by Acts of Congress or under the 
provisions of the general incorporation law, authorized and 
empowered to license persons to practise the art and science 
of medicine without a uniform and even without any stand- 
ard of qualification beyond the ability and willingness of the 
licentiate to pay the required fees or give promissory notes 
for the payment of the same ; and under the provision of the 
general incorporation law any dozen citizens may obtain a 
charter, upon the payment of the fee for the record of the 
same, authorizing them, as a body corporate, to confer the 
degree of M.D. at their pleasure and will. To these must 
be added the system of voodoo medicine, with its shocking 
sorceries and incantations; the physio- medical system of in- 
tuitive medicine, with its supernatural attributes ; and the 
White Cross University and Yivopathic System, boasting of 
" little teaching" as the only necessary qualification of its 
graduates. 



ESSAYS AND ADDRESSES. 353 

If such data are not sufficient incentive to unite you in 
some common effort to correct abuses and establish a higher 
and uniform standard of medical education, then examine the 
records of the " examining-boards " in the States where medi- 
cal practice laws are in force. I will only cite that of the 
" Board of Medical Examiners " of Virginia, from the date 
of its organization, January 1, 1885, to October, 1895 ; dur- 
ing which period it rejected, on first examinations, two hun- 
dred and sixty-nine out of nine hundred and eighteen appli- 
cants for license, or 29.30 per centum of graduates of seventy- 
five medical schools, including some of the highest repute, 
located, with three exceptions, in eighteen States and Terri- 
tories of this country. 

Of the six New England States, Maine, Massachusetts, and 
New Hampshire have no legal requirement for the practice of 
medicine. 

First class. In Alabama, Arkansas, Florida, Maryland, 
Minnesota, Mississippi, New Jersey, New York, North 
Carolina, North Dakota, Pennsylvania, South Dakota, 
Ehode Island, Texas, Utah, Virginia, and Washington the 
diploma confers no right to practise and has no legal value, 
except, in some cases, to give its possessor standing before an 
examining-board. The right to practise in each of these 
seventeen States is determined by examinations before boards 
of examiners enacted by law. 

Second class. In California, Colorado, Connecticut, Dela- 
ware, Illinois, Iowa, Kentucky, Louisiana, Missouri, Mon- 
tana, Nebraska, New Mexico, Oklahoma, Oregon, Tennessee, 
Vermont, and West Virginia the diploma is subject to the 
supervision of some designated body vested by law with au- 
thority to determine its validity as evidence of its possessor's 
qualification for the practice of medicine. Failing the pos- 
session of such recognized diplomas, the right to practise may 
be acquired by passing a satisfactory examination. 

Third class. In Arizona, Georgia, Idaho, Indiana, Kan- 

23 



354 ESSAYS AND ADDRESSES. 

sas, Michigan, Nevada, Ohio, 1 South Carolina, Wisconsin, 
and Wyoming the presentation of any kind of a diploma, 
provided only that it be from a " chartered" medical insti- 
tution, is sufficient in law for couuty clerks, clerks of courts, 
registrars of deeds, and similarly qualified judges of medical 
fitness to admit to practice. — Journal of the American Medical 
Association, March 10, 1894. 

It thus appears that in the first class the restrictive legis- 
lation is complete and sufficient to protect the communities 
in the respective States from ignorance and charlatanry. In 
the second class, with competent aud efficient boards of ex- 
aminers, the protection can only be partially satisfactory, but 
is far preferable to the loose aud ill-constructed laws in 
operation in the third class of States. 

With the view of renewing the negotiations to effect some 
agreement with the Homoeopathic Medical Society, I wrote, 
October 21st, to Dr. J. B. Gregg Custis, to which his reply 
is as follows : 

" November 1, 1895. 

" Dear Dr. Busey : Your esteemed favor of October 
21st duly received. 

"Nothing would give the Homoeopathic Medical Society 

1 An unanswered letter : 

H. N. TEETERS, D.D.S., M.D., H. N. TEETERS, D.D.S., M.D., 

Specialist Dbuggist. 

in Fine Gold Mallet Fillings, Gold Crowns Squibs & Powers and Weightman's Goods 

and Bridge Work. Always on Hand. 

Teeth Extracted Without Pain. Prescriptions Carefully Compounded. 

And New Ones Inserted in Five Minutes. No. 153 Main Street. 

Office 151 Main Street. Open Day and Night. 
Open Day and Night. 

MONONGAHELA, PA., NOV 1st 1895 

Sec District Medicle Society, 

Washington D C 
Dear Dr 

What is the Fee for Certificate of Medicle Society to Practice Medicine in D C Can 
I go before a Notary Public here and make Affidavit as to Qualification and forward 
to you with Fee and secure the Certificate Without being Present 

I am at Present Practicing Medicine and Dentistry in Steubenville Ohio and Am 
thinking of Moving to D C 
Please let Me hear from You as soon as Possible. 
Yours Respt 

H. N. TEETERS M D, D D S 

417 Dock Street 
Steubenville Ohio 



ESSAYS AND ADDRESSES. 355 

greater pleasure than that it should be able to agree with 
the Society you so ably represent on a bill to be presented 
to Congress, and one which the two associations could make a 
common cause. We had intended to introduce a bill similar 
to that introduced by Senator Teller in the last Congress, 
known as Senate bill No. 2645, a copy of which I enclose. 

" You will remember that after some consultation, and in 
deference to your wishes, we accepted several amendments to 
that bill, which we will gladly embody in the new one. The 
amendments are as follows : 

" 1. After the word ' Columbia,' in section 1, line 6, 
strike out the paragraph beginning i The members of one 
board,' down to the word ( The/ in line 9, same section, and 
insert in lieu thereof the words ' one board shall be composed 
of five physicians in good standing, adherents of the " regular" 
school of practice.' 

" We would much prefer to have the five selected from 
members of the Medical Society. If it is possible, and we 
are not misinformed as to the standing of the Medical Asso- 
ciation of the District of Columbia, we would suggest a sub- 
stitute for the above amendment : One board shall be com- 
posed of five physicians in good standing, members of the 
Medical Association of the District of Columbia. I believe 
that this removes the objection made by graduates of Harvard 
University, as they are eligible for membership in that body. 

" 2. After the word i licenses,' section 4, line 5, insert ' no 
questions except such as have been approved by a majority 
of said committee shall be used in any examination.' 

"I will state here that we must insist upon equal repre- 
sentation on the Committee on Examinations. You will 
remember that the Commissioners, at the suggestion of the 
health officer, proposed that a committee be composed of five 
members, two of whom should not be members of the boards, 
and that we objected, which objection we will have to main- 
tain, unless it be stated that the remaining members be gov- 
ernment officials and not physicians. 



356 ESSAYS AND ADDBESSES. 

" 3. Section 6, line 22, after the word 6 Columbia/ insert 
' when any set of examination-papers has been finally acted 
upon, it shall be filed in the health office of the District of 
Columbia, subject to the inspection of the Examining Com- 
mittee or any member thereof. ' 

" Section 7, line 9, strike out all after the word i turpi- 
tude,' down to the word ' In,' line 10, same section. 

' ' The last two amendments were made, I believe, to meet 
the objections of some of the District Committee. 

" Our committee will be glad to receive and give careful 
attention to any suggestions that may please you to make. 

i ' Hoping that for the good of the city and welfare of its 
citizens our efforts before Congress may meet with success,, 
I am, Very truly yours, 

"J. B. Gregg Custis, 

" Chairman." 

"S. C. Busey, M.D., 

" President Medical Society of the District of Columbia." 

The committee met November 7th, and, after consideration 
of the subject, unanimously agreed to present to Congress the 
bill S. 325, entitled "A bill to regulate the practice of medi- 
cine in the District of Columbia," a copy of which was 
mailed to Dr. Custis November 28, 1895, to which his 
reply is as follows : 

"Washington, D. C, November 30, 1895. 

"S. C. Busey, M.D., 

" Chairman Committee of Medical Legislation, Medical Society of the 
District of Columbia. 

" Dear Sir : It gives me great pleasure to announce the 
approval of our committee to the bill as forwarded to me 
this day by Dr. Woodward, and to pledge our support of 
the same without alteration or amendment. 

" Expressing the hope that our united efforts may secure 
its early enactment as a law, I am 

" Yours most respectfully, 

" J. B. Gregg Custis, 

" Chairman of Committee." 



ESSAYS AND ADDBESSES. 357 

I am, therefore, authorized to announce to you a satisfac- 
tory conclusion of these negotiations, and the very favorable 
prospects of adequate legislation in the near future that will, 
at least in some measure, mitigate the evils of which we com- 
plain and offer protection to this community from the influx 
of charlatans and impostors, and, moreover, the prospective 
advance in the higher education of medical men (see Senate 
bill 325, first session, 54th Congress). 

This bill has been approved by the Commissioners of the 
District of Columbia and forwarded to the Senate with their 
recommendation. 

Society Publication of its Transactions. 

The first attempt of this Society to publish its transactions 
was in the form of a quarterly bulletin of twenty-four pages 
in accordance with the following schedule : 

"At a regular meeting of the Society, held November 12, 
1873, Dr. S. C. Busey offered the following resolution, which 
was adopted : 

" 'Resolved, That the Committee on Essays be and are 
hereby requested to inquire into the expediency and expense 
of publishing a bulletin of the debates before the Society, and 
to report in writing, with such recommendation as may be 
deemed proper.' " 

Novejibek 19, 1873: 

" The Committee on Essays, which was requested by a 
resolution passed at the last meeting to inquire into the ex- 
pediency and expense of publishing a bulletin of the debates 
before the Society, etc., beg to make the following report: 

"1. The committee believe it would be eminently proper 
and expedient for the Society to publish reports of its pro- 
ceedings. Such a course, they conceive, would enhance the 
usefulness of the Society, stimulate its members to present 
better papers and essays, and tend to improve the scientific 
character of its debates. 



358 ESSAYS AND ADDRESSES. 

" 2. The committee recommend that the material selected 
for publication shall be confined to the following several 
heads : 

" (a) Original theories or synopsis of papers containing 
such theories. 

11 (b) Original modes of practice. 

" (c) Cases testing modes of practice still sub judice. 

' ' (d) Cases deserving of record from their being curious or 
rare. 

" (e) New facts, experiments, or discoveries appertaining 
to medicine and its allied sciences. 

" (/) Such parts of debates as it may be deemed by this 
committee would, if published, be of general interest to the 
profession at large or tend to promote the advancement of 
medical science. 

" 3. The committee recommend that the published report 
or bulletin be issued quarterly, and that it shall bear on its 
title-page the words * Transactions of the Medical Society of 
the District of Columbia. 7 

" 4. The committee, on inquiry, find the expense of pub- 
lication in pamphlet-form, octavo page of 48 lines, solid print, 
and without cover, will be for 12 pages (500 copies) twenty- 
five dollars per quarter ; for twenty-four pages (500 copies) 
fifty dollars per quarter ; or, respectively, one hundred or 
two hundred dollars per year. 

" 5. The committee recommend that a pamphlet of twenty- 
four pages, the number of copies 500, be printed quarterly, 
and that an appropriation of fifty dollars per quarter from 
the treasury of the Society be applied to the payment of the 
expense incurred. 

" B. Thompson, M.D., 
"A. F. A. King, M.D., 
" Chas. E. Hagnek, M.D., 

" Committee." 

The issue of these quarterly bulletins commenced in April, 
1874, and ceased in July, 1878, with the completion of 



ESSAYS AND ADDRESSES. 359 

Volume IV. of the Transactions of the Medical Society of 
the District of Columbia. Subsequently an arrangement was 
made with the Maryland Medical Journal, and later with 
the Journal of the American Medical Association, for the 
publication of its transactions, which proved so unsatisfac- 
tory it was discontinued. Several years ago an agreement 
was perfected with the National Medical Review for the pub- 
lication of an abstract of the discussions, which continues in 
operation to date. 

It is not my purpose to interfere with the existing arrange- 
ment, beyond the statement that it is inadequate and unsatis- 
factory. This Society is quite up to the highest standard of 
similar organizations in attendance, capacity, and activity, 
but lacks means and opportunity to establish its reputation 
before the profession at large. The publication of individual 
contributions in medical journals, selected by personal prefer- 
ence, with the foot-note accrediting its presentation to this 
Society, is not objectionable, and tends to extend the reputa- 
tion of the author, but adds but little, if any, to the standing 
of this Society. This privilege should not be abridged or 
discontinued. The ownership of the essay, and right of pub- 
lication when and in such manner as he pleases, should be- 
long to the author. The Society should not hold the exclu- 
sive right of priority of publication of the essays read before 
it without great injustice to the authors. The delay in the 
preparation and publication of a society bulletin or volume 
of transactions would prove a serious obstacle to the presenta- 
tion of papers of immediate, original, and scientific value, and 
necessarily exclude such from the current proceedings. 

I disclaim any purpose to interfere with or to restrict the 
rights and privileges of authors, and am equally averse to the 
erection of any hindrance to the attainment and promotion 
of individual reputations. I do, however, hold and seek to 
enforce the conclusion that the higher and more widely dis- 
seminated the scientific character and standing of this Society, 
the more accentuated and distinctive its membership. The 



360 ESSAYS AND ADDRESSES. 

world of science recognizes membership in some one or more 
of many scientific organizations as the badge of honor, ca- 
pacity, and achievement. Such I would make membership of 
this Society. The graduates of the University of Pennsyl- 
vania passed, on first examinations daring the past ten years, 
without a single failure, the Medical Examining Board of 
Virginia. Who, then, will deny to such graduates the honor 
of the affix of the university to their degrees of M.D.? 
This is only one, but a significant citation. Many others 
might be attested. The qualification and capacity of her 
graduates were proved, but the individual success was no 
higher than the honor of every other successful applicant on 
first examination. The uuiform success of all was, however, 
a distinction of which their alma mater cau boast. So, like- 
wise, may each one of a score of essayists successfully pass 
the crucible of current criticism and receive the commenda- 
tion of his peers; but it is the publication of the essays in 
some concrete and permanent form that will establish and 
maintain the reputation of the Society which honors the au- 
thors with membership. I concede the high distinction to 
which many of you have attained, and bear testimony to the 
merit of your contributions to medical literature and science, 
but I also plead for that reciprocal impetus to higher distinc- 
tion which can only be developed by the combination of indi- 
vidual and organized effort. 

During the two years past of my presidency there have 
been read before this Society many papers that would have 
added to the reputation of any medical society in this coun- 
try, but their permanent value, except to the few, has been 
frittered away in the mass of current journal literature. 
What has established the world-wide and enduring reputa- 
tions of the London Obstetrical Society, the American Gyne- 
cological Society, the Association of American Physicians, 
and many other equally renowned societies? The student, 
scholar, and investigator seeks facts, not men. He does not 
go to the biographies and autobiographical sketches of the 



ESSAYS ASD ADDRESSES. 361 

cyclopaedias of distinguished physicians, but turns the pages 
of the volume of transactions in search of the information and 
instruction desired. 

In this connection I recall your attention to the essays read 
and the discussions thereon in this Society in the past two 
years on " Tuberculosis, " Typhoid Fever/' " Hydropho- 
bia/' aud "Diphtheria," which are far in advance of any 
similar consideration of those subjects by any medical society 
in this countrv, and vet their value as society investigations 
has been so completely frittered away that the members can- 
not revive their recollections by referring to their publication. 

Some, perhaps many of you, will think that I have under- 
taken an enterprise more fanciful than practical. My reliance 
upon my knowledge of human nature, which I have gleaned 
from personal association with and observation of medical 
men, has brought me to the conclusion that a majority of 
men of reputation seek to record the evidence of their success 
and achievements in some permanent form. And even those 
who pursue the profession for a mere livelihood or gain are 
not without hope that their better qualities and good deeds 
may not be hopelessly forgotten. 

I believe, with the committee of 1873, that a society pub- 
lication, preferably an annual volume of transactions, with- 
out infringement or abridgment of the private rights and 
ownership of authors, would " enhance the usefulness of the 
Society, stimulate its members to present better papers and 
essays, and tend to improve the scientific character of its de- 
bates." And, moreover, that the continuous publication to 
date of the bulletin of 1873— '78 would have added immeas- 
urably to the standing of this Society in the profession-at- 
large. 

The single objection of expense, I hope, will not be worthy 
of consideration by a society of two hundred and seventy- 
seven active members, that adds annually to its surplus on 
an assessment of three dollars per capita. 

In conclusion, I avail mvself of this occasion to record, in 



362 ESSAYS AND ADDRESSES. 

this formal manner, the expression of gratitude to this Society 
for the sympathy and good-wishes set forth in the resolutions 
of April 10, 1895. This memorial, together with the indi- 
vidual testimonials of sympathy from one hundred and more 
members of this Society, has been filed among the archives 
of my professional life, in grateful remembrance of that good- 
will and prompt significance of those qualities of Christian 
sympathy which move the great brotherhood of medicine to 
the noblest deeds of benevolence and tender kindliness of 
heart. If I could measure the pleasure and consolation those 
outpourings of " the milk of human kindness " brought to 
the victim of inexcusable and culpable negligence during 
the hours and days of acute suffering, my words would empha- 
size that sublime ideal of gratitude which can be felt but can- 
not be spoken. 

From others, many times greater in number, from among 
the great mass of good people, came also tokens in various 
forms of manifest sympathy, in evidence of the fact that 
humanity grows richer in the ennobling qualities of the 
mind and heart with the progress of Christianity and civili- 
zation. 

Then, too, this Society should invoke the continued bless- 
ing of Providence, that has restored, with but one death 
during the year, so many members to health and usefulness 
who have been afflicted with sickness well-nigh to the utmost 
limit of human endurance. 



ESSAYS AND ADDRESSES. 



363 



BILL RELATING TO TESTIMONY OF 
PHYSICIANS. 

REPORT OF COMMITTEE OX BILL RELATING TO TESTIMONY 

OF PHYSICIANS IN THE COURTS OF THE DISTRICT 

OF COLUMBIA, 1896. 

1545 IST..N. W., 
"Washington City, D. C, February, 1896. 

Hon. John ^Y. Ross, 

President of the Board of Commissioners, D. C. 

Sir : The bill H. R. No. 2647, entitled "A bill relating 
to the testimony of physicians in the Courts of the District of 
Columbia," has been drafted and presented to Congress by 
direction of the Medical Society of the District of Columbia. 
It is modelled after the law of the State of New York, and 
is substantially the same as similar laws in force in twenty 
States and one Territory of this country, the first of which 
was enacted by the State of Oregon in 1872, and the latest in 
1887 by the States of Indiana, Wyoming, Montana, and Idaho. 

The following list includes the States, with the year, page, 
and section of the statute-book in which the law is to be 
found : 



States. 




Year. 


Page. 


Sec. 


Arkansas, 


Stat. 


1883 


625 


2862 


California, 


Code C. P. . 


1885 




1881 


Colorado, 


Gen. Stats. . 


1883 


1062 


4 


Dakota, 


Comp. Laws . 


1887 


910 


5313 


Idaho, 


Rev. Stat. 


1887 


679 




Indiana, 


Rev. Stat. 


. 1887 


679 


497 


Iowa, 


Rev. Code 


1884 


860 




Kansas, 


Comp. Law . 


1885 


645 


323 


Michigan, 


Gen. Stat.. . 


1882 


1889 


7516 and S6 


Minnesota, 


Gen. Stat. . 


1881 


792 


10 


Missouri, 


Rev. Stat. . 


1879 


690 


4017 


Montana, 


Comp. Stat. . 


. 1887 


230 


Civ. Cod. 650 


Nevada, 


Gen. Stat. . . 


1885 


833 


3406-84 


New York, 


Code C. P. . 


(4 Rev. 


Stat. 164) 


834 


Ohio, 


Rev. Stat. 


1884 


1096 


5241 


Oregon, 


Gen. Law 


1872 


251 




Utah, 


Comp. Laws . 


1876 


506 




Washington, 


Code . 


1881 


102 


392 


Wisconsin, 


Rev. Stat. 


1878 


992 


4075 


"Wyoming, 


Rev. Stat. 


1887 


590 


2589 


Oklahoma Territory. 









364 ESSAYS AND ADDRESSES. 

The opposition to the enactment of this bill is set forth in 
the protest of six justices of the Supreme Court of the Dis- 
trict of Columbia, now on file with the Board of Commis- 
sioners of the District of Columbia, to which I am directed 
by the Committee of the Medical Society of the District of 
Columbia to make reply as follows : 

The medical profession in this District holds in high esteem 
the justices of the Supreme Court of the District of Colum- 
bia, as well for their learning and judicial ability as for their 
personal standing and integrity ; but it is surprised that they 
should unite in a formal protest against the enactment of this 
bill, which has for its object the extension to the citizen of 
the liberty of privileged communications, and for his protec- 
tion in the enjoyment of the right of unrestricted and confiden- 
tial confession to his physician, now denied him by the com- 
mon law in force in this District and enforced by the said six 
justices of the Supreme Court of the District of Columbia. It 
is quite reasonable to suppose there are in either House of 
Congress many men who, for the time being, are discreet 
legislators and fully qualified to determine the utility and 
wisdom of such laws, to whom the Medical Society will ap- 
peal with the hope of securing the passage of H. R. bill No. 
2647, the opposition of the justices of said court to the con- 
trary notwithstanding, and it will continue to prosecute its 
purpose with unabated zeal until success shall crown its efforts. 

It is not known to the Medical Society, nor to any member 
thereof, that any organized opposition, either judicial or popu- 
lar, has been made to the enforcement of such laws in any of 
the States in which such statutes exist, or that any effort has 
been made to repeal them, or that any conflict exists in re- 
gard to their utility and justice. It must, therefore, at least 
be inferred that the wisdom of such statute protection of physi- 
cians from enforced disclosure of the confidential communica- 
tions of patients has been established, and it remains only to 
extend such protection to less favored communities. 

The bill is intended to protect physicians from the com- 



ESSAYS AND ADDRESSES. 365 

pulsory disclosure of information acquired in a professional 
capacity, and which may be necessary to enable them to man- 
age cases of sickness with intelligence and success. It fre- 
quently occurs that patients will conceal important, and some- 
times absolutely necessary information, and occasionally will 
deny the existence or previous occurrence of certain circum- 
stances or conditions alleged by the physician, until admis- 
sion or confession is extorted by some statements of the physi- 
cian that longer concealment or denial would prove dangerous 
and perhaps fatal. It is a recognized principle of law that a 
witness cannot be forced to criminate himself. Surely infor- 
mation extorted by a physician, or communicated to him in 
the confidence of a confiding patient, should be equally in- 
violable as information known only to the witness himself. 
If a witness cannot be compelled to criminate himself directly 
by confession in open court, is it not gross injustice to compel 
him to criminate himself indirectly by the compulsory dis- 
closure of his confession or confidential communication to his 
physician made under duress, fright, or emotional impulse ? 

If a man unwillingly confesses some circumstance, incident, 
or vice of his life to a physician, to enable that physician to 
treat an existing ailment with intelligence, is it more than 
exact justice to grant him the right of refusing permission to 
such physician to disclose in open court such confidential 
communication ? The bill is intended to protect the patient 
from such indirect and involuntary crimination of himself, 
and compulsory disclosure of a secret confided to his friend 
and physician. 

The second paragraph of the protest of the six justices sets 
forth three averments in opposition to this bill : 

1. " New York is the only Atlantic Coast State" that 
has adopted such a law. 

2. ' ' Arkansas is the sole Southern State " in which such 
a statute exists. 

3. " The legislation is comparatively recent, and of the 
States adopting it all are quite young except those just 



366 ESSAYS AND ADDRESSES. 

mentioned " (New York and Arkansas), and California, In- 
diana, Iowa, Kansas, Michigan, Minnesota, Missouri, Ohio, 
and Wisconsin. 

The third averment carries with it the emphatic contra- 
diction of the averment of recency, because of the admission 
that it is inapplicable to eleven of the twenty States in which 
such statutes exist. If the averment of recency was true, 
how would such fact disprove or lessen the wisdom aud jus- 
tice of such laws ? On the contrary, it would seem to estab- 
lish the equity of such legislation, because in evidence of the 
progress of a higher civilization and broader conception of 
private rights and privileges. The progress of civilization 
during the past twenty-four years (the first law dates back 
to 1872) has not been more clearly shown than in the many 
recent statutory modifications of and exemptions from legal 
traditions than by such legislation in the States named, which 
has exempted twenty-seven (census of 1890) millions of the 
citizens of this country from such compulsory disclosures. 

The citation of one Atlantic coast and one Southern State 
is even more fallacious, and partakes of the nature of a deri- 
sive appeal to geographical, sectional, or local prejudices. 
New York is the largest, most populous, and wealthiest of 
the original thirteen States. Why, then, may not her statute 
of exemption be accepted as testimony in support of the jus- 
tice of such legislation, all the more strongly so because, as 
yet, there has been neither judicial nor popular remonstrance 
against such statutory protection of physicians from the com- 
pulsory disclosure of the confidential communications of her 
sick citizens ? And, surely, Arkansas is old enough and her 
citizens are sufficiently advanced in civilization to know how 
best to protect her citizens in their private rights and privi- 
leges. So far, then, these two States may be cited as exem- 
plars worthy of the emulation of other sister States still lag- 
ging in the tradition of the common law transmitted to us 
from English descent. 

The Medical Society of the District of Columbia, as does 



ESSAYS AND ADDRESSES. 367 

the medical profession-at-large, admits (see third paragraph of 
protest) the justice of the exemption of legal advisers from 
enforced disclosure of the secrets of their clients ; but it can- 
not be admitted that such confidential communications are 
more sacred than the confidences of sick people. Legal ad- 
visers and attorneys are for the most part concerned with liti- 
gants, and their confidential information relates mainly to 
business matters and property values. The confidences of 
the physician refer most especially, and in most instances 
exclusively, to personal conditions, character, temperament, 
idiosyncrasies, vices, indiscretions of life, family history, in- 
herited predispositions and diseases, and avoidable and un- 
avoidable afflictions, social as well as pathological, and all 
this in the interest of health, longevity, and life. If these 
two widely different classes of confidences could be measured 
by any common or uniform standard, those of the physician 
would rise far above those of the attorney on the scale of in- 
violability. 

It is stated in the same paragraph that if the privilege was 
not " extended to communications between legal adviser and 
client," " no man would dare consult a professional adviser 
with a view to his defence or the enforcement of his rights." 
The predicate and postulate are both conceded, and it is 
equally true that " no man would dare consult" his medical 
adviser with a view to the treatment and cure of disease if 
he knew that his confidential communications and confessions 
would be disclosed in open court. " The privilege extended 
to communications between legal advisers and client at com- 
mon law " is based upon public policy, but that fact cannot 
justify the limitation of the privilege exclusively to the legal 
profession, nor is it believed that popular judgment, always 
the safest depositary of power, will sustain such contention. 

Under the common law the physician cannot protect him- 
self from compulsory disclosure of confidential communica- 
tions, nor can the common law be amended ; relief can, there- 
fore, only be obtained by statute law enacted by the Legisla- 



368 ESSAYS AND ADDRESSES. 

ture. The patient should be protected in the unreserved and 
fearless statement of his ailment and its cause. Suppose, for 
instance, an erring man by a candid confession aided his 
physician in the diagnosis of syphilis contracted by illicit 
intercourse and is treated to his own advantage and to the 
protection of his wife and unborn children. If he knew his 
medical attendant could be compelled to convict him of adul- 
tery, he would hesitate to make such confession, to his destruc- 
tion and the ruin of his family. 

According to the census of 1890, twenty-seven millions 
four hundred and seventy-two thousand and two hundred and 
ninety-six citizens of this country have been exempted by State 
legislation from such compulsory disclosures as are set forth 
in the bills H. of E. No. 2647 and Senate 981. These bills 
seek to guarantee to this community the same protection. 
The original bill was prepared by a distinguished attorney 
of the local bar, after a careful examination of the statutes 
in the twenty States. This simple statement of facts is a 
conclusive answer to the protest of the six justices, and estab- 
lishes the wisdom and justice of such legislation. 
I have the honor to be 

Your obedient servant, 

Samuel C. Busey, 

President of the Medical Society of the 
District of Columbia. 



EULOGY. 



DELIVERED BY THE PRESIDENT BEFORE THE MEDICAL 

SOCIETY OF THE DISTRICT OF COLUMBIA, 

OCTOBER 21, 1896. 

Gentlemen : It becomes my duty formally to announce 
to you the death of Dr. Joseph Meredith Toner, who died 
July 31st at Cresson Springs, Pennsylvania, where he had 
gone to escape the heat of the city and pass his summer 



ESSAYS AND ADDRESSES. 369 

vacation. A few days before my departure from the city, 
late in June last, I called at his residence to take leave of 
him. After a brief visit we parted with mutual good-wishes 
for a pleasant and healthful summer vacation and return to 
our accustomed places and duties with improved health and 
vigor. Each of us knew the other's failing health and de- 
clining life, but his genial countenance, cheerful words, and 
cordial manuer left no remembrance of the malady that would 
surely, sooner or later, prove fatal to him. 

I do not recall any circumstance that freshened my recol- 
lection of that final parting until the news of his voiceless 
and painless death came to me while sitting alone by the 
window of my room looking out upon the waves of the open 
sea as they came rolling in and dashed " high on a stern and 
rock-bound coast," breaking into spray that sparkled in the 
gleaming light of the setting sun, and then flowed back with 
the ebb of the surging water into the deep sea. The moment, 
incident, and scene shrouded thought with sadness, and the 
mental picture of that last parting was so vivid and the words 
of that last good-by so pronounced that it seemed as if I was 
in his presence, accepting his valediction ; and then the pic- 
ture broadened out in expanded outline as the memory revived 
the recollection of the incidents of forty and one years of an 
acquaintance and companionship now broken to waste in the 
wreck of time. 

I have been present on many occasions similar to this, for 
many, very many, members of this Society have died during 
the past forty-eight years ; but it has not before fallen to my 
lot to witness the last tribute of respect to the memory of one 
whose friendly and fraternal companionship I had enjoyed 
through so many years of professional life. There are but 
eight others now living whose membership began before Or 
is coeval with his, who can unite with me in giving expres- 
sion to our sorrow at the loss of one whom we honored dur- 
ing life and mourn in death. 

Memory is crowded with the incidents and circumstances 

24 



370 ESSAYS AND ADDRESSES. 

of four decades and one year of contemporaneous association 
which bear testimony to his courage, fidelity, sincerity, and 
impartiality. To an attractive address, courteous demeanor, 
and genial temperament were added truth, Justice, and mag- 
nanimity. 

It is not, then, surprising that those of us who knew him 
so many years should mourn the death of a friend whose 
nature and character were so richly blessed with the nobler 
qualities of the human heart and mind. His good offices and 
friendships were not limited to his lifelong companions and 
colaborers of oar profession, but were as widely extended 
as his acquaintanceship among the later membership of this 
Society and in the community-at-large. The positions of 
trust and honor to which the profession in this District and 
in the country called him, to some of which but few can hope 
to attain, testify to his worth as a man, his standing as a 
physician, and his fidelity to duty. This Society will hold 
his memory in honored remembrance as the faithful historian, 
who through years of painstaking and laborious investigation 
collated the early history of the profession in this District 
from municipal and national records, newspaper publications, 
family reminiscences, legend, and tradition. He verified and 
arranged the data with such accuracy and completeness in 
an address delivered September 26, 1866, that it is now and 
always will be accepted as the standard history of the medi- 
cal profession of this District prior to 1866. 

Dr. Toner was neither a brilliant man nor a profound 
thinker, but he was eminent and conspicuous as a patient, 
industrious, and honest student. These qualities he applied 
with assiduity and sincerity to every purpose he sought to 
accomplish. He was eminently and acutely truthful. He 
had the courage of his convictions with the will and force 
to maintain them, but always so tempered with magnanimity 
and foregiveness that the crimination and bitterness of dis- 
agreement and controversy were either wholly obliterated or 
so mollified that his friendships were purified and intensified. 



ESSAYS AND ADDRESSES. 371 

His social standing and moral character were above re- 
proach. He stood upon the highest plane of etiquette and 
ethics, but was never an offensive partisan, and set au ex- 
ample worthy of emulation by the most punctilious and 
circumspect. 

His investigations and studies related mainly to medical 
and local histories, and his chosen fields of labor and re- 
search referred to subjects which had been, for the most 
part, entirely neglected, but which required persistent pur- 
suit, accurate and impartial judgment, a well-balanced fac- 
ulty of analysis, and a keen and quick perception of mistake 
and misrepresentation. He had so trained his mind that 
these qualities constituted the routine method of his thought 
and brought to his aid such ready and accurate knowledge 
that made him a living and walking repository of a vast 
amount of useful information sifted down to its absolute 
value and accuracy. He was uot only a " fact hunter," but 
a hunter of useful facts, and of facts hidden in musty and 
forgotten archives, obscured by reminiscent and traditional 
misrepresentation. He rediscovered, rehabilitated, and util- 
ized facts for the common good. It was a phenomenal com- 
bination of habits of body, traits of mind, and trend of 
thought that enabled him to accomplish so much that will 
make the task of those who may follow along the same lines 
of research and study easy and profitable. 

He has left several curious, unique, and valuable illustra- 
tions of this peculiar trend of thought and mind that strike 
one, at first glance, as the work of one who was busy wast- 
ing time for something better to do, but those who know the 
value of such facts will testify to his accuracy and originality 
of method of verification, arrangement, and classification. The 
Medical Register, of the District of Columbia ; Dictionary of 
Elevations and ClimaticRegister ; Plan of Geographical Classi- 
fication, denoting by symbols the location of the counties of 
each State of the Union, adopted and now in use by the 
Postoffice Department ; Collections of Maps and Rare Rec- 



372 ESS A YS AND ADDRESSES. 

ords, which show the boundary-lines of the farms as they 
existed when this city was laid out, which accompanies the 
work entitled Washington in Embryo ; and Alphabetical List 
of the Names of all Persons Residing in Washington and the 
District of Columbia, June 1, 1880, Aged Seventy-five Years 
and More, compiled from the census of 1880, are terse ex- 
pressions of mental characteristics, original in conception, 
unique in utility, and enduring in history with the name of 
Toner. I may, with excusable pride, add to these citations 
his address to the Rocky Mountain Medical Association, de- 
livered June 6, 1877, in which, with most commendable in- 
dustry, he classified and arranged the facts and data collected 
from the histories of all peoples and tribes of all ages and 
times, from which he deduced the following conclusion, set 
forth in the last two sentences of the address : 

" Everywhere and in every age, among all tribes and 
people, whether the most savage or the most highly civilized, 
may be traced the presence of the physician. He was ever 
deemed a necessity, and his standing and influence have 
everywhere been commensurate with his high and honorable 
office, which won for him in the Apostolic age the appella- 
tion of the ' Beloved Physician/ " 



MEDICAL SOCIETY OF THE DISTRICT OF 
COLUMBIA. 

THE YEAR 1896 : AN EPOCH IN THE HISTORY OF THE MED- 
ICAL SOCIETY OF THE DISTRICT OF COLUMBIA. 
ANNUAL ADDRESS DELIVERED BY THE 
PRESIDENT, DECEMBER 16, 1896. 

Gentlemen : The events that have occurred during the 
year are of such signal and lasting importance as to consti- 
tute an epoch in the history of this Society and of the pro- 
fession in this District. It is, therefore, my duty as it will 



ESSAYS AND ADDRESSES. 373 

be my pleasure to chronicle and arrange the facts that add 
such unusual interest to the transactions of a single year, 
with the hope that they may mark the beginning of a new era 
in the history of scientific medicine at the capital of the nation. 

After years of continuous but unsuccessful efforts Congress 
has enacted a law " to regulate the practice of medicine and 
surgery, to license physicians and surgeons, and to punish 
persons violating the provisions thereof in the District of 
Columbia/' Mark the significance of the words, " to punish 
persons violating the provisions thereof." The law may not 
be as full and complete in its protective and prohibitory pro- 
visions as some of us would desire, but it offers the profession 
and community protection from the continuous annual influx 
of charlatans and mercenary impostors to which this city had 
become exposed because of proscriptive legislation in forty- 
seven States and Territories of the country. This beneficent 
result cannot, however, be immediately accomplished, because 
the former lax administration of loose regulations has per- 
mitted the registration of some eminently qualified in the art 
of charlatanry and fraud, whose vested rights cannot be alien- 
ated by ex post facto legislation, but must abide the issue of 
longevity and the judicious regulation of their unscrupulous 
and venal methods. I will not trench upon the privileges 
and prerogatives of the Board of Medical Supervisors by an 
attempt to interpret or define certain special provisions of the 
law, but I am confident that a fair, impartial, and vigorous 
execution of such provisions, of which I have no doubt, will 
so restrict the methods of this objectionable class that we may 
reasonably hope for satisfactory results. 

A second and no less important object of the law seeks the 
elevation of the standard of scientific education and profes- 
sional qualification — a standard attainable only by the gradu- 
ates of the highest grade of medical schools. Nothing less 
will be satisfactory to the advanced methods of teaching along 
the lines of scientific and clinical research. Nothing less 
should satisfy the demand of an intelligent community for 



374 ESSAYS AND ADDRESSES. 

the highest skill in preventive and practical medicine, and 
nothing else will so effectively diminish the prevalence and 
lessen the pecuniary success of quackery in the management 
and treatment of disease. 

The examination by the Board of Examiners under the 
supervision of the Board of Supervisors will compel medical 
colleges to establish a higher standard for graduation. Com- 
plete equipment in knowledge, clinical experience, and train- 
ing of successful applicants for registration will, ipso facto, 
conduce to the greater skill and proficiency of beginners in 
the practice of medicine. As a natural consequence practi- 
tioners of standing and reputation must keep abreast with the 
progress of scientific medicine or flag in competition with 
their more skilful and better educated juniors. Many, per- 
haps most, people will seek those surgeons and physicians 
who offer best results with the least suffering. Brilliant suc- 
cess attaches only to phenomenal skill, and the time is per- 
haps not very remote when success will be the measure of 
qualification and attainments. This law will hasten the com- 
ing of such a desirable result. 

Controversies will arise and judicial construction will be 
invoked. The law contemplates important reformations, 
which can only be accomplished by unremitting and cour- 
ageous fidelity to the duties and obligations we have volun- 
tarily imposed upon ourselves and our successors. We must 
popularize its mandatory and reformatory provisions by 
united and active support of the Boards of Examiners and 
Supervisors in their efforts to administer the trust confided to 
their judgment and discretion. 

It would be out of place here and a fruitless waste of 
time to narrate to you the embarrassments, perplexities, and 
meddlesome outside interference which beset the Committee 
on Legislation 1 of this and of the Washington Homoeopathic 

< 1 Committee of the Medical Society of the District of Columbia : Drs. Samuel C. 
Busey, W. W. Johnston, C H. A. Kleinschmidt, Z. T. Sowers, George L. Magruder 
George W. Cook, J. S. McLain, Charles G. Stone, and W. C Woodward. 

Committee of the Washington Homoeopathic Medical Society : Drs. J. B. Gregg 
Custis, W. R. King, J. B. Swormsteadt, W. F. Corey, and F. A. Gardner. 



ESSAYS AND ADDRESSES. 375 

Medical Society, to whose conjoint effort and harmonious 
co-operation we are indebted for the enactment of the law. 
Suffice it to say that from the date of the introduction of the 
bill agreed upon by the two committees into the two Houses 
of Congress it was necessary to watch and follow it with in- 
trepid vigilance through every stage of its progress until it 
was approved by the President. In fact, it practically passed 
both Houses of Congress three times before it reached the 
final act of approval by the President, and could not again 
be interpolated through the mistaken zeal of some unknown 
but sinister investigator. Through the active co-operation 
and zeal of Senator J. H. Gallinger and the Hon. John W. 
Babcock it finally became a law in the form agreed upon by 
the two Houses of Congress. 

The "Act to provide for the incorporation and regulation 
of Medical Colleges in the District of Columbia," which orig- 
inated with the Washington Homoeopathic Medical Society, 
was accepted by your committee as a measure adding force to 
and promoting the reforms contemplated by the Medical Prac- 
tice Act. The necessity and wisdom of its enactment were so 
apparent that it met with but feeble opposition, which con- 
sisted of some vehement declamation in defence of one or 
more institutions claiming charters under the general incor- 
poration law, one of which was without a habitation, combined 
all the chairs of a university in the person of one professor, 
and confessed to two matriculates and one graduate. But, 
whatever may be the status of the institutions caught " in 
durance vile," the law will effectively prohibit the future 
establishment of medical schools without proper and ade- 
quate equipment to teach medicine at least according to some 
one of the systems legally recognized in this District. The 
law may not be as comprehensive in its requirements as the 
adherents of the system of scientific medicine to which this 
Society belongs, would formulate, yet it is an important ad- 
vance in the policy of legal control and regulation of medical 
schools in this District, and will prevent the multiplication of 



376 ESSAYS AND ADDRESSES. 

the class of bogus medical schools which have turned loose 
upon a credulous public so many ignorant frauds and venal 
charlatans. It is the beginning of the end of mills that 
grind out diplomas at so much per square inch of parchment. 

The third of the series of statutory reforms, entitled an 
"Act relating to the testimony of physicians in the courts of 
the District of Columbia," is not less important than either 
of the Acts previously referred to, and is more distinctly sig- 
nificant of the power and influence of a united profession 
than either of them. The bill originated with Dr. Z. T. 
Sowers, at whose suggestion I presented it to this Society at 
the meeting held March 2, 1892, but it was not presented to 
either House of Congress until December, 1895, and then by 
Senator Justin S. Morrill, in the Senate, and Hon. John W. 
Babcock, in the House. The opposition of the justices of 
the Supreme Court of the District of Columbia was so for- 
midable it seemed, for a time, impossible to secure favorable 
reports from the committees on the District of Columbia of 
the Houses of Congress ; but finally, due mainly to the as- 
siduous and vigilant efforts of several members of your Com- 
mittee on Legislation, reports were made by both committees 
with the unanimous recommendation of its passage, which 
was done without dissent in either branch of Congress. I 
regret to add that it became a law by constitutional limita- 
tion, without the approval of the President. 

This law has for its object the extension to the citizens of 
this District of the liberty of privileged communications and 
their protection in the enjoyment of the rights of unreserved 
and confidential confession to physicians, and is similar in 
import and effect to laws in force in twenty States and one 
Territory of this country, and not unlike, though far less 
comprehensive, than the law of France. It is not, therefore, 
a new principle of law, but the extension of a principle, the 
utility and justice of which seem to be established by twenty 
and more years of experience in several of the States in which 
such statutes have been in force. 



ESSAYS AND ADDRESSES. 377 

It adds the force and fiat of law to the decree of the medi- 
cal profession, which has always and everywhere throughout 
the civilized world resisted the compulsory disclosure in open 
court of information ' i acquired in attending a patient in a 
professional capacity, and which was necessary to enable the 
physician to act in such capacity." The inviolability of the 
confidences of the sick-room is the most sacred precept of 
professional life. It has come to us through the ages past as 
an unbroken rule of conduct, and all codes of medical ethics 
have stigmatized with dishonor the voluntary disclosure of 
such confidences. It is not then surprising that we should 
felicitate ourselves in this hour of triumph and vindication 
of the honor of our profession, and legalization of the con- 
fidential relation of the profession with the people-at-large, 
in whose interest and for whose protection this statute has 
been enacted. It is the assertion of one of the highest pre- 
rogatives of the medical profession and the reassurance of its 
fidelity to the sacred obligation of inviolability of professional 
confidence. 

At the meeting held January 22, 1896, this Society adopted 
a series of propositions relating to the sanitation of this city, 
setting forth the necessity of extension and purification of the 
water-supply, extension and completion of a system of foul- 
water and sewage disposal, and compulsory connection of 
habitable and inhabited houses with such systems of water- 
supply and sewerage. At the same time it charged the Com- 
mittee on Legislation with the duty of presenting these propo- 
sitions to Congress and urging the necessary legislation. . Of 
these propositions one has become a law, and the one that 
most directly challenges the prejudice and antagonism of the 
unfortunate, poorer, and unhygienic classes of the popula- 
tion, and the only one that charges its cost upon the lot- 
holders, and holds the owner responsible for its execution. 
As a purely sanitary measure the compulsory connection of 
habitable and inhabited houses with the systems of water- 
supply and sewers is, perhaps, most important in promoting 



378 ESSAYS AND ADDRESSES. 

the hygiene of person and dwelling, and in the prevention 
of soil-pollution because of the consequent abolishment of 
privy-boxes, cesspools, and other makeshifts for the collec- 
tion of human excreta. We also have reason to believe that 
the facts and arguments presented to the respective Congres- 
sional committees carried sufficient weight to secure fair 
appropriations, aud have thus enabled the Commissioners to 
provide for the extension of suburban sewers and supply 
residents of Brightwood and Takoma with Potomac water. 
Surely, then, notwithstanding the failure of our effort in the 
aggregate, we have reason to congratulate ourselves and the 
people of the city upon the prospective improvement in the 
sanitation of the city and health of its residents. But our 
duty to the public will not be fully discharged until such 
additional legislation is secured as will complete the systems 
of a pure water-supply and for the ultimate disposal of 
sewage. 

I will not disguise the pride I take in adding these enact- 
ments to the record of reforms inaugurated during my 
incumbency of the presidency of this Society, nor conceal 
the pleasure it gives me to realize the fulfilment, though 
incomplete, of our duty in conservation of the health, well- 
being, and happiness of this people. Much remains to be 
done. The education of the general public in sanitation is 
a slow and tedious process, but the profession must continue 
to lead and direct popular opinion in all matters pertaining 
to the knowledge and advancement of sanitary science and 
preventive medicine. 

So much for the legislative reforms. The history of this 
epochal year will, however, be incomplete without special 
reference to the resumption of the systematic publication of 
the transactions of the Society. The publication contem- 
plates the record in a permanent form, accessible to our 
successors and to the profession-at-large, of the scientific 
work of its members, and thereby the elevation of the stand- 
ing and the establishment of the reputation of the Society 



ESSAYS AND ADDRESSES. 379 

upon the highest plane of scientific and clinical medicine. I 
have, on a former occasion, expressed the opinion that the 
work of the members of this Society will compare favorably 
with that of any medical organization in this country. I am 
assured now that it will attain and maintain the position to 
which it is entitled, which will redound to the honor of its 
membership. 

The present plan and arrangement may be incomplete in 
some details, but it will contribute to the permanent estab- 
lishment and enlarged usefulness of a local medical journal, 
in some measure under the control of the Committee of 
Editors, a desideratum second only in importance to the per- 
manent preservation of the transactions of the Society, and 
alike contributory to the fulfilment of the charter-declaration 
to promote and disseminate medical and surgical knowledge. 
Mark you the significance of the provisions of the charter, 
that authorizes and directs the body corporate to " alien, sell, 
transfer, or lease " any property or securities acquired by 
"gift, bargain, sale, or demise/' " and apply to such pur- 
poses as they may judge most conducive to the promoting 
and disseminating medical and surgical knowledge, and for 
no other purpose whatsoever." 

The repealing section of the Medical Practice Act elimi- 
nates from the charter every franchise of object and purpose 
except the duty of "promoting and disseminating medical 
and surgical knowledge " in such manner as the Society 
" may adjudge most conducive." The scheme and plan of 
publication adopted, if not adequate to the complete discharge 
of such duty, is an effort in that direction, which can be per- 
fected as experience may indicate its defects and insufficien- 
cies. It may not be the only method, but it is one that will 
disseminate medical and surgical knowledge. For many 
years this Society has restricted its scientific work to such 
consideration within closed doors. Now it has emphasized 
the beginning of a new era by the extension of its advantages 
to others than those who may regularly attend its weekly 



380 ESSAYS AND ADDRESSES. 

meetings. Every practitioner of medicine must know that 
the present progress of scientific medicine throughout the 
civilized world is due mainly to the widespread dissemination 
of discovery and knowledge through the mediums of medical 
journals and medical society publications ; and it is equally 
true that every such publication has, in some measure, con- 
tributed to the diffusion of useful knowledge. It must, then, 
follow that this Society can only and completely discharge its 
duty to the profession-at-large and to mankind in general by 
the record and publication of its scientific work. The clini- 
cal demonstration of the value and utility of a discovery is 
not less important than the discovery. The multiplication 
of clinical results obtained by different investigators in sepa- 
rate localities, regions, and countries is the only crucial and 
conclusive test of the value, utility, and application of new 
facts, improved methods, and progress. If the transactions 
of the Society were limited to original thought and investiga- 
tion and discovery, research would continue without verifica- 
tion, and recorded clinical observation and experience and 
experimental attestation would be eliminated from the educa- 
tional facilities of organized effort. In 1889 a physician pub- 
lished the unsuccessful results of experimental sponge-grafting 
in the orbit of a rabbit. In 1896 a member of this Society 
presented the history and partial successful result of experi- 
mental sponge-grafting in the human orbit. The conception 
was original with each experimenter, the latter not knowing 
the failure of the first. Without publication of the failure 
of one and success of the other, either result might have been 
accepted as final ; but with all the facts and data open to all, 
the priority of failure or success will be determined by the 
clinical observation and experience of careful, painstaking, 
and competent observers who may have preceded or will fol- 
low in the same line of investigation. Such is the rule and 
conduct of medical workers to discover facts or to co-ordinate 
them into laws. Facts in medical science and practice can 
only be established by concurrent investigation, observation, 



ESSAYS AND ADDRESSES. 381 

and verification by competent experts. Specialism in medi- 
cine owes its marvellous progress and popularity to concen- 
tration of effort and systematic publication. General prac- 
tice owes its decadency to desultory diffuseness of thought, 
waste of opportunity, and complaisant disregard of progres- 
sive methods. The attempt now being made to build upon 
the ruins of its decay the specialism of internal medicine can- 
not find a region of the human body that has not been in- 
vaded by an aggressive if not a rapacious specialism. 

Medical society organization and consideration, with the 
conflict of judgment and experience, is an active and effective 
instrumentality in the correction of mistake, fallacy, miscon- 
ception, and misapplication. All these averments lead up to 
and emphasize the postulate that the systematic record and 
publication of the scientific work of a medical society are an 
imperative duty to itself and to the profession-at-large, and 
a potential auxiliary to the acquisition, promotion, and dis- 
semination of medical and surgical knowledge. Then let it 
be our pride, as it is our duty, to make our transactions such 
a repository of scientific and clinical knowledge as will reflect 
honor and distinction upon its membership. 

The record of this epoch year sets forth with unmistakable 
significance the power and force of a united profession, and 
emphasizes its unquestionable right to assert itself in all 
matters pertaining to the elevation and advancement of a 
beneficent and life-saving profession, and to the promotion 
of the welfare, health, and longevity of the people. Through 
all times and among all civilized peoples the profession of 
medicine has taken the lead in all such reforms, and, when- 
ever and wherever it has asserted the force and activity of 
united action, success has crowned its efforts. Ghouls, harpies, 
vampires, innate critics, and malevolent satirists have feasted 
upon the credulity of the ignorant in futile and venal struggles 
to obstruct and throttle progress. But scientific medicine — 
the handmaid of religion and benefactor of the human race — 
has steadily advanced along the path that leads to its high 



382 ESSAYS AND ADDRESSES. 

goal, neither swayed by the formalities of society nor dis- 
mayed by the convulsions of popular sentiment, and now 
commands the respect and homage of the civilized world. 
Rancor, jealousy, and dissension have, in times past, so com- 
pletely dissipated effort and influence that the profession as a 
body well-nigh, for the time being, slunk into an occupation 
for individual gain and emolument and personal aggrandize- 
ment, inciting ridicule, popular prejudice, and widespread 
skepticism. Happily a new era dawned in the universal 
demand for a higher standard of education and qualification, 
and more general and vigorous enforcement of the precepts 
of a conscientious and qualified discharge of the duties and 
responsibilities of a beneficent and life-saving science. 

Scientific medicine must fail in its mission of humanity and 
beneficence in so far as it falls short of asserting the inalien- 
able right to lead, direct, control, and dominate popular 
ignorance, prejudice, and cupidity, to the end that legislators 
and all others in authority must come to know its force and 
power in all things pertaining to the advancement of sani- 
tary science and preventive medicine. The art of healing 
cannot be dissociated from the science of prevention. The 
eradication of preventable diseases is the highest aim of 
medical and biological science, and to that end research 
must go on, untrammelled by authority and free from the 
restraints of malevolent skepticism. 

The education and betterment of the people-at-large in 
sanitation are not less humane than the healing of the sick. 
During the past three years this Society has made creditable 
progress in this department of medical polity, in that it has 
asserted its right, privilege, and duty to seek and promote 
such legislation as would conduce to the advancement of 
scientific medicine and to the welfare of this community; 
and now, in the closing hour of this session, it has the proud 
satisfaction of summing up the results of its efforts to widen 
the scope of its activities in the interest of and for the good 
of the people. 



f) IQ/' 



